Harold Hamm Diabetes Center and Section of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
J Diabetes Complications. 2013 Nov-Dec;27(6):627-32. doi: 10.1016/j.jdiacomp.2013.05.005. Epub 2013 Aug 1.
The VADT was a randomized clinical trial designed to assess the effect of intensive vs. standard glucose management on cardiovascular events in Type 2 diabetes. At the end of the study, intensive management failed to improve outcomes. We performed plasma lipoprotein subclass analyses to yield new information on the effects of study randomization on cardiovascular risk.
This is a cross-sectional study of a subset of the VADT (740 men: 368 intensive; 372 standard), conducted at least six months (mean±SD: 2.1±0.8years) post-randomization. Conventional lipids, apolipoprotein-defined (ADLS) lipoprotein subclasses, ApoCIII, ApoE, and Nuclear Magnetic Resonance (NMR) lipoprotein subclasses were determined.
In intensive vs. standard groups, conventional lipids and ADLS did not differ significantly. However, with intensive treatment, NMR-determined large and medium VLDL subclasses and VLDL diameter were lower, LDL diameter was higher, medium HDL was higher, and small HDL was lower (all p<0.05). Also, ApoCIII levels were lower (p<0.01).
In a subset of diabetic men from the VADT, intensive glucose management did not affect conventional lipids or ADLS, but had some beneficial effects on particle characteristics as defined by NMR and on ApoCIII.
VADT 是一项随机临床试验，旨在评估强化与标准血糖管理对 2 型糖尿病患者心血管事件的影响。研究结束时，强化治疗未能改善结局。我们进行了血浆脂蛋白亚类分析，以提供关于研究随机分组对心血管风险影响的新信息。
这是 VADT 的一项亚组横断面研究（740 名男性：368 名强化组；372 名标准组），至少在随机分组后 6 个月（平均值±标准差：2.1±0.8 年）进行。测定了常规脂质、载脂蛋白定义的（ADLS）脂蛋白亚类、ApoCIII、ApoE 和核磁共振（NMR）脂蛋白亚类。
与标准组相比，强化组的常规脂质和 ADLS 没有显著差异。然而，采用强化治疗时，NMR 测定的大、中 VLDL 亚类和 VLDL 直径降低，LDL 直径升高，中 HDL 升高，小 HDL 降低（均 p<0.05）。此外，ApoCIII 水平也降低（p<0.01）。
在 VADT 的一组糖尿病男性亚组中，强化血糖管理并未影响常规脂质或 ADLS，但对 NMR 定义的颗粒特征和 ApoCIII 有一些有益影响。
