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Insulin Therapy, Glycemic Control, and Cardiovascular Risk Factors in Young Latin Americans with Type 2 Diabetes Mellitus
  1. Larissa Avilés-Santa,
  2. Karin Salinas,
  3. Beverley Adams-Huet,
  4. Philip Raskin
  1. From the Department of Internal Medicine (L.A.-S., K.S., P.R.) and General Clinical Research Center (B.A.-H.), The University of Texas Southwestern Medical Center at Dallas, Dallas, TX. This project was sponsored in part by the National Institutes of Diabetes, Digestive and Kidney Diseases (K08 award DK 02606) and the National Institutes for General Clinical Research Centers (M01-RR00633)
  1. Address correspondence to: Dr. Larissa Avilés-Santa, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd G5.238, Dallas, TX 75390-8858; e-mail: Maines.Aviles-Santa{at}UTSouthwestern.edu.

Abstract

Background Type 2 diabetes has been linked to an increased risk of cardiovascular (CV) disease, but this risk has not been well documented in young patients, especially of Latin American descent. Also, the potential CV benefits of insulin therapy have not been evaluated in young patients with type 2 diabetes. The objectives of this study were to determine any gender-related difference in the presence of CV risk factors in young Latin Americans with poorly controlled type 2 diabetes and the effect of intensive insulin therapy on these CV risk factors.

Methods and Results Fifty-seven Latin American patients with type 2 diabetes between the ages 18 and 45 years were evaluated at baseline. All women were premenopausal and had regular menstrual periods. The mean body mass index (BMI) was > 30 kg/m2 in both genders. Percent body fat, percent hemoglobin A1c, and lipoprotein profiles were similar between genders. Highly sensitive C-reactive protein (CRP) levels were elevated and similar between genders (p = .4). Leukocyte adhesion molecules (intercellular adhesion molecule 1, vascular adhesion molecule 1, E-selectin) and monocyte chemoattractant protein 1 were elevated, whereas adiponectin levels were below normal in both gender groups. Urinary albumin excretion was similar between genders and did not show any relationship with any of the variables. In women, there was a direct relationship between waist circumference and high-sensitivity CRP levels (rho = .53, p = .01). No other significant relationships were observed. Eighteen Latin American patients with type 2 diabetes completed up to 104 weeks of postintervention with insulin monotherapy. In these patients, glycemic, lipoprotein, and anthropometric measurements were obtained every 12 weeks. Highly sensitive CRP, leukocyte adhesion molecules, and urinary albumin excretion, among other tests, were obtained every 52 weeks. At 52 and 104 weeks, body weight, BMI, waist circumference, and percent body fat increased in a parallel and significant manner. Despite a significant decrease in percent hemoglobin A1c (22.2%; p = < .0001), lipid and lipoprotein profiles, highly sensitive CRP, leukocyte adhesion molecules, and other nontraditional CV risk factors did not change significantly.

Conclusions In young, obese, Latino type 2 diabetic patients, improvement in glycemic control with insulin monotherapy was not associated with a parallel improvement in markers of vascular inflammation. Premenopausal Latino women with uncontrolled type 2 diabetes have CV risks comparable to Latino diabetic men of the same age. Obesity and underlying insulin resistance may counteract the potential CV benefits associated with insulin therapy in lean diabetic patients. Weight loss could be a potential therapeutic modality to improve CV risk in Latino type 2 diabetic patients, especially women.

Key Words
  • diabetes mellitus
  • insulin therapy
  • endothelium-derived factors
  • inflammation
  • insulin resistance
  • obesity
  • Latin Americans

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