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The influence of insulin pump treatment on metabolic syndrome parameters in type 2 diabetes mellitus

Einfluss einer Insulinpumpentherapie auf Parameter des metabolischen Syndroms bei Typ 2 Diabetikern

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Zusammenfassung

EINLEITUNG: Ziel unserer Studie war es, den Einfluss einer Langzeitbehandlung mit Insulinpumpen (CSII) auf Parameter des metabolischen Syndroms bei insulinresistenten schlecht eingestellten Typ 2 Diabetikern zu untersuchen. PATIENTEN UND METHODEN: Es wurden 13 adipöse (BMI >30 kg/m2) Patienten (8 Frauen, 5 Männer; mittleres Alter 58,8 ± 9,06 Jahre), die mindestens 12 Monate mit hohen Insulindosen (>0,8IU/kg/24 h) behandelt worden waren, in die Studie aufgenommen. Bevor die CSII Behandlung begonnen wurde, wurden alle Patienten nochmals bezüglich der Behandlung des Diabetes mellitus und des metabolischen Syndroms geschult. Parameter der Blutzuckerkontrolle wurden erfasst. Zur Evaluierung der Insulinresistenz wurden hyperinsulinämische euglykämische Clamp-Untersuchungen durchgeführt. Die Untersuchungen wurden nach 6 Monaten der Therapie mit CSII wiederholt. Der Wilcoxon-Vorzeichen-Rang-Test sowie Spearmans Rangkorrelationskoeffizient wurden zur statistischen Berechnung verwendet. Die Ergebnisse werden als Mediane (1. und 3. Quartile) angegeben. ERGEBNISSE: Bezüglich der Langzeitkontrolle der Glykämie traten keine Änderung nach der Behandlung mit CSII auf: Das HbA1c lag vor der CSII bei 9,6% (8,95; 10,60), nach 6 Monaten bei 9,80 (9,50; 10,20) %, der BMI änderte sich von 33,0 (32,1; 34,2) auf 32,9 (32,0; 34,5) kg/m2 und die tägliche Gesamt-Insulindosis war ebenfalls praktisch gleich (69,0 (65,0; 94,0) vs. 68,0 (58,9; 92,4) IU/24 h). Allerdings wurde eine statistisch signifikante Besserung der Insulinresistenz: M Wert CSII: 2,55 (1,92; 3,15) vs. 3,32 (2,23; 4,49) mg/kg/min (p < 0,01) nach CSII, sowie folgender Risikofaktoren der Atherosklerose (Koagulation, endotheliale Dysfunktion) gefunden: Fibrinogen 3,44 (3,13; 3,86) vs. 3,24 (2,77; 3,38) g/l, Faktor VII 115 (101; 128) vs. 109 (93; 119) %, Faktor VIII 230 (148; 260) vs. 188 (126; 225) %, vWF:RiCo 162 (141; 193) vs. 128 (100; 132) %, PAI-1 39 (30; 44) vs. 30 (25; 36) AU/ml, Thrombomodulin Ag 4,1 (3,7; 4,4) vs. 3,7 (3,45; 4.05) ng/ml (p < 0.01) festgestellt. SCHLUSSFOLGERUNGEN: Eine 6-monatige Insulinpumpentherapie führte bei übergewichtigen Typ 2 Diabetikern unabhängig von der Blutzuckereinstellung zu einem Abfall der Insulin-resistenz, und zu einer Besserung von Parametern des Fettstoffwechsels, der Koagulation des Bluts und der endothelialen Funktion.

Summary

INTRODUCTION: The aim of our study was to evaluate the influence of long-term insulin pump treatment (CSII) on the parameters of metabolic syndrome in insulin-resistant patients with poorly controlled type 2 diabetes mellitus. PATIENTS AND METHODS: Thirteen obese (BMI >30) patients (8 women, 5 men), average age 58.8 ± 9.06 years, treated with an intensified insulin regimen with high doses of insulin (>0.8 IU/kg per 24 h) for at least 12 months were enrolled in the study. Prior to CSII treatment, all patients were reeducated regarding diabetes treatment and metabolic syndrome, and glycemic control parameters were assessed. Insulin resistance was evaluated with the hyperinsulinemic euglycemic clamp test. All tests were repeated after six months of CSII treatment. The Wilcoxon matched-pairs signed-rank test and Spearman's rank correlation coefficient were used for statistical evaluation. Results are presented as median (1st quartile; 3rd quartile). RESULTS: There were no changes in long-term glycemic control during the course of CSII treatment: HbA1c prior to CSII 9.60 (8.95; 10.60) vs. after 6 months 9.80 (9.50; 10.20) %, BMI 33.0 (32.1; 34.2) vs. 32.9 (32.0; 34.5), total daily insulin dose 69.0 (65.0; 94.0) vs. 68.0 (58.9; 92.4) IU/24 h in observed patients. There was a statistically significant improvement in insulin resistance: M value 2.55 (1.92; 3.15) vs. 3.32 (2.23; 4.49) mg/kg per min (P < 0.01), and improvement in atherosclerosis risk factors (blood coagulation and endothelial dysfunction): fibrinogen 3.44 (3.13; 3.86) vs. 3.24 (2.77; 3.38) g/l, factor VII 115 (101; 128) vs. 109 (93; 119) %, factor VIII 230 (148; 260) vs. 188 (126; 225) %, vWF:RiCo 162 (141; 193) vs. 128 (100; 132) %, PAI-1 39 (30; 44) vs. 30 (25; 36) AU/ml, thrombomodulin Ag 4.1 (3.7; 4.4) vs. 3.7 (3.45; 4.05) ng/ml (P < 0.01). CONCLUSIONS: Six months of CSII treatment led to decrease in insulin resistance and improvement in parameters of lipid metabolism, blood coagulation and endothelial dysfunction independently of glycemic control and weight.

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Authors and Affiliations

  1. Medical Department I, University Hospital, Plzen, Czech Republic

    Zdenek Jankovec, Daniela Cechurova, Michal Krcma, Silvie Lacigova, Michal Zourek & Zdenek Rusavy

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  1. Zdenek Jankovec
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  2. Daniela Cechurova
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  3. Michal Krcma
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  4. Silvie Lacigova
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  5. Michal Zourek
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  6. Zdenek Rusavy
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Correspondence to Zdenek Jankovec.

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Jankovec, Z., Cechurova, D., Krcma, M. et al. The influence of insulin pump treatment on metabolic syndrome parameters in type 2 diabetes mellitus. Wien Klin Wochenschr 121, 459–463 (2009). https://doi.org/10.1007/s00508-009-1203-x

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  • DOI: https://doi.org/10.1007/s00508-009-1203-x

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