Emanuele N, Azad N, Abraira C, Henderson W, Colwell J, Levin S, Nuttall F, Comstock J, Sawin C, Silbert C, Marcovina S, Lee H S
Hines Veterans Affairs Hospital, Ill 60141, USA.
Arch Intern Med. 1998;158(22):2485-90. doi: 10.1001/archinte.158.22.2485.
The Veterans Affairs Cooperative Study in Type II Diabetes Mellitus prospectively studied insulin-treated patients with type 2 (non-insulin-dependent) diabetes mellitus, achieving 2.1% glycosylated hemoglobin separation between intensive- and standard-treatment arms (P<.001) for 2 years.
To assess the effect of intensive therapy on serum fibrinogen and lipid levels, compared with standard treatment.
One hundred fifty-three male subjects with type 2 diabetes mellitus and who required insulin treatment were recruited from 5 Veterans Affairs medical centers. The subjects were divided into intensive- and standard-treatment arms for a randomized prospective study. Dyslipidemia was managed identically in both arms (diet, drugs). Fibrinogen levels and lipid fractions were measured in the full cohort. Lipid fractions are separately reported in patients not treated with hypolipidemic agents.
There were no baseline differences between arms. Fibrinogen levels rose in the intensive-treatment arm at 1 year (from 3.34+/-0.12 to 3.75+/-0.15 g/L; P<.001) but returned to baseline at 2 years (3.47+/-0.12 g/L). There was no change in the standard-treatment arm. Triglyceride levels decreased in the intensive-treatment arm from 2.25+/-0.27 to 1.54+/-0.14 mmol/L (199+/-24 to 136+/-12 mg/ dL) at 1 year (P = .004) and to 1.74+/-0.18 mmol/L (154+/-16 mg/dL) at 2 years (P = .03); there was no change in the standard-treatment arm. Cholesterol levels decreased in the intensive-treatment arm at 1 year from 5.4+/-0.21 to 4.99+/-0.13 mmol/L (207+/-8 to 193+/-5 mg/dL) (P = .02); there was no change in the standard-treatment arm. Levels of low- and high-density lipoprotein cholesterol decreased in the standard-treatment arm only by 2 years, from 3.44+/-0.13 to 3.16+/-0.10 mmol/L (133+/-5 to 122+/-4 mg/ dL) (P =.02) and from 1.10+/-0.03 to 1.00+/-0.03 mmol/L (42+/-1 to 38+/-1 mg/dL) (P<.001) for low-density and high-density lipoprotein cholesterol, respectively. Levels of apolipoprotein B decreased in both treatment arms (P<.001), and apolipoprotein A1 levels decreased in the standard-treatment arm (P<.01). Lipoprotein (a) levels did not change in either treatment arm. Lipid results were essentially identical whether examined in the full cohort or excluding those patients receiving hypolipidemic agents.
Intensive insulin therapy led to a potentially beneficial reduction in serum triglyceride levels and preservation of high-density lipoprotein cholesterol and apolipoprotein A1 levels. However, it caused transient elevation in plasma fibrinogen levels, a possible thrombogenic effect.
退伍军人事务部II型糖尿病合作研究对胰岛素治疗的2型（非胰岛素依赖型）糖尿病患者进行了前瞻性研究，强化治疗组和标准治疗组之间糖化血红蛋白水平在2年内分离度达2.1%（P<0.001）。
评估与标准治疗相比，强化治疗对血清纤维蛋白原和血脂水平的影响。
从5个退伍军人事务医疗中心招募了153名需要胰岛素治疗的男性2型糖尿病患者。将受试者分为强化治疗组和标准治疗组进行随机前瞻性研究。两组对血脂异常的管理方式相同（饮食、药物）。对整个队列测量纤维蛋白原水平和血脂成分。在未接受降血脂药物治疗的患者中分别报告血脂成分。
两组之间基线无差异。强化治疗组纤维蛋白原水平在1年时升高（从3.34±0.12升至3.75±0.15 g/L；P<0.001），但在2年时恢复至基线水平（3.47±0.12 g/L）。标准治疗组无变化。强化治疗组甘油三酯水平在1年时从2.25±0.27降至1.54±0.14 mmol/L（199±24至136±12 mg/dL）（P = 0.004），在2年时降至1.74±0.18 mmol/L（154±16 mg/dL）（P = 0.03）；标准治疗组无变化。强化治疗组胆固醇水平在1年时从5.4±0.21降至4.99±0.13 mmol/L（207±8至193±5 mg/dL）（P = 0.02）；标准治疗组无变化。仅在2年时标准治疗组的低密度和高密度脂蛋白胆固醇水平下降，低密度脂蛋白胆固醇从3.44±0.13降至3.16±0.10 mmol/L（133±5至122±4 mg/dL）（P = 0.02），高密度脂蛋白胆固醇从1.10±0.03降至1.00±0.03 mmol/L（42±1至38±1 mg/dL）（P<0.001）。两个治疗组载脂蛋白B水平均下降（P<0.001），标准治疗组载脂蛋白A1水平下降（P<0.01）。两个治疗组脂蛋白（a）水平均无变化。无论在整个队列中检查还是排除接受降血脂药物治疗的患者，血脂结果基本相同。
强化胰岛素治疗导致血清甘油三酯水平潜在有益降低，并维持高密度脂蛋白胆固醇和载脂蛋白A1水平。然而，它导致血浆纤维蛋白原水平短暂升高，可能具有促血栓形成作用。
