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  • Title: [Cardiovascular risk factors and treatment with insulin in type II diabetic patients in whom oral hypoglycemic drugs have failed].
    Author: Calle Pascual AL, Calle Fernández JR.
    Journal: Med Clin (Barc); 1993 Jun 26; 101(5):165-7. PubMed ID: 8332008.
    Abstract:
    BACKGROUND: To find whether insulin treatment in type II diabetic patients in whom treatment with oral hypoglycemic treatment has failed changes body fat distribution or modifies cardiovascular risk factors. METHODS: Twenty-six patients (16 women and 10 men with a mean age of 62.3 +/- 9.8 years and 12.8 +/- 8.5 years of evolution) were studied before and 3 months after starting insulin treatment at a daily dose of 0.3 IU/kg of body weight. RESULTS: HbA1c decreased from 9.9 +/- 2.1 to 8.2 +/- 1.6% (p < 0.001) similar to fructosamine (from 407 +/- 86 to 350 +/- 71 mumol/l; p < 0.001) following treatment with insulin, but a increase in body weight, body mass index, blood pressure and a decrease in the concentration of HDL-cholesterol (p < 0.05) were observed. Weight was gained in 21 patients (80%) (3.7 +/- 1.9 kg), increasing body fat of central distribution in 13 (50%) and of peripheral distribution in 8 (30%). The patients in whom body fat of central distribution was increased fundamentally differentiated from the remaining patients by having a greater body mass index (p < 0.01), in all cases greater than 25 kg/m2 upon initiation of the insulin treatment, and by a significantly greater increase in body weight, blood pressure and total cholesterol after the insulin treatment. Patients who increased body fat of peripheral distribution or who did not gain weight did not present these changes in cardiovascular risk factors and were characterized by an increase of at least 500 kcal/week consumed by physical exercise. CONCLUSIONS: Treatment with insulin in type 2 diabetic patients in whom oral hypoglycemic drugs have failed improves glycemic control, but induces an increase in weight and worsens cardiovascular risk factors in patients with a CMI greater than 25 kg/m2. This change may be prevented by an increase in physical activity.
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