Mustonen J, Laakso M, Uusitupa M, Sarlund H, Pyörälä K, Rautio P, Kuikka J, Länsimies E
Department of Medicine, Kuopio University Central Hospital, Finland.
Diabetes Res. 1988 Sep;9(1):27-30.
Left ventricular function was evaluated noninvasively before and three months after starting insulin treatment in nine patients (mean age 61.8 years, range 51-68 years) with non-insulin dependent diabetes showing an impaired insulin secretion capacity. After starting insulin treatment, fasting blood glucose decreased from 12.9 +/- 0.5 mmol/l (mean +/- SEM) to 9.8 +/- 1.2 mmol/l (p = 0.03), but the decrease of glycosylated haemoglobin Alc was not significant (9.0 +/- 0.4% vs. 8.3 +/- 0.6%). On systolic time intervals, PEP/LVET ratio improved from 0.44 +/- 0.03 to 0.37 +/- 0.02 (p = 0.03). On M-mode echocardiography, E-F slope became steeper (89 +/- 6 mm/sec vs. 103 +/- 8 mm/sec; p = 0.01) but no significant changes were observed in other variables reflecting diastolic or systolic function. On equilibrium radionuclide angiocardiography, the left ventricular ejection fraction at rest was similar before and after starting insulin treatment (48.6 +/- 3.2% vs. 49.2 +/- 2.8%) but during peak exercise the left ventricular ejection fraction improved significantly (51.0 +/- 5.3% vs. 59.9 +/- 4.7%; p = 0.02). The change of PEP/LVET ratio correlated significantly with the changes of blood glucose and glycosylated haemoglobin Alc levels, but the correlation between these metabolic variables and the change of left ventricular ejection fraction during exercise did not reach statistical significance. In conclusion, the left ventricular function improved concomitantly with improved metabolic control after starting insulin treatment in middle-aged patients with non-insulin-dependent diabetes having an impairment in insulin secretion capacity. This finding suggests that metabolic factors are involved in the left ventricular dysfunction observed in diabetes.
对9例胰岛素分泌能力受损的非胰岛素依赖型糖尿病患者（平均年龄61.8岁，范围51 - 68岁）在开始胰岛素治疗前及治疗3个月后进行了无创性左心室功能评估。开始胰岛素治疗后，空腹血糖从12.9±0.5 mmol/l（均值±标准误）降至9.8±1.2 mmol/l（p = 0.03），但糖化血红蛋白Alc的降低不显著（9.0±0.4%对8.3±0.6%）。在收缩期时间间期方面，PEP/LVET比值从0.44±0.03改善至0.37±0.02（p = 0.03）。在M型超声心动图检查中，E - F斜率变陡（89±6 mm/秒对103±8 mm/秒；p = 0.01），但在反映舒张或收缩功能的其他变量中未观察到显著变化。在平衡放射性核素心血管造影检查中，开始胰岛素治疗前后静息时左心室射血分数相似（48.6±3.2%对49.2±2.8%），但在运动高峰时左心室射血分数显著改善（51.0±5.3%对59.9±4.7%；p = 0.02）。PEP/LVET比值的变化与血糖及糖化血红蛋白Alc水平的变化显著相关，但这些代谢变量与运动期间左心室射血分数变化之间的相关性未达到统计学显著性。总之，在胰岛素分泌能力受损的中年非胰岛素依赖型糖尿病患者中，开始胰岛素治疗后左心室功能随着代谢控制的改善而改善。这一发现提示代谢因素参与了糖尿病中观察到的左心室功能障碍。
