Effect of intensive glycemic control on fibrinogen, lipids, and lipoproteins: Veterans Affairs Cooperative Study in Type II Diabetes Mellitus

Nicholas Emanuele, Nasrin Azad, Carlos Abraira, William Henderson, John Colwell, Seymour Levin, Frank Nuttall, John Comstock, Clark Sawin, Cynthia Silbert, Santica Marcovina, Hae Sook Lee

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background: 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. Objective: To assess the effect of intensive therapy on serum fibrinogen and lipid levels, compared with standard treatment. Methods: 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. Results: 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 19325 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 highdensity 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. Conclusions: 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.

Original languageEnglish
Pages (from-to)2485-2490
Number of pages6
JournalArchives of Internal Medicine
Volume158
Issue number22
StatePublished - Dec 7 1998

Fingerprint

Veterans
Fibrinogen
Type 2 Diabetes Mellitus
Lipoproteins
Lipids
Therapeutics
Hypolipidemic Agents
Apolipoprotein A-I
Insulin
HDL Cholesterol
Triglycerides
Lipoprotein(a)
Glycosylated Hemoglobin A
Apolipoproteins B
Dyslipidemias
Serum
LDL Cholesterol

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Emanuele, N., Azad, N., Abraira, C., Henderson, W., Colwell, J., Levin, S., ... Lee, H. S. (1998). Effect of intensive glycemic control on fibrinogen, lipids, and lipoproteins: Veterans Affairs Cooperative Study in Type II Diabetes Mellitus. Archives of Internal Medicine, 158(22), 2485-2490.

Effect of intensive glycemic control on fibrinogen, lipids, and lipoproteins : Veterans Affairs Cooperative Study in Type II Diabetes Mellitus. / Emanuele, Nicholas; Azad, Nasrin; Abraira, Carlos; Henderson, William; Colwell, John; Levin, Seymour; Nuttall, Frank; Comstock, John; Sawin, Clark; Silbert, Cynthia; Marcovina, Santica; Lee, Hae Sook.

In: Archives of Internal Medicine, Vol. 158, No. 22, 07.12.1998, p. 2485-2490.

Research output: Contribution to journalArticle

Emanuele, N, Azad, N, Abraira, C, Henderson, W, Colwell, J, Levin, S, Nuttall, F, Comstock, J, Sawin, C, Silbert, C, Marcovina, S & Lee, HS 1998, 'Effect of intensive glycemic control on fibrinogen, lipids, and lipoproteins: Veterans Affairs Cooperative Study in Type II Diabetes Mellitus', Archives of Internal Medicine, vol. 158, no. 22, pp. 2485-2490.
Emanuele, Nicholas ; Azad, Nasrin ; Abraira, Carlos ; Henderson, William ; Colwell, John ; Levin, Seymour ; Nuttall, Frank ; Comstock, John ; Sawin, Clark ; Silbert, Cynthia ; Marcovina, Santica ; Lee, Hae Sook. / Effect of intensive glycemic control on fibrinogen, lipids, and lipoproteins : Veterans Affairs Cooperative Study in Type II Diabetes Mellitus. In: Archives of Internal Medicine. 1998 ; Vol. 158, No. 22. pp. 2485-2490.
@article{96910517c786422f8e2eee53a62df384,
title = "Effect of intensive glycemic control on fibrinogen, lipids, and lipoproteins: Veterans Affairs Cooperative Study in Type II Diabetes Mellitus",
abstract = "Background: 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. Objective: To assess the effect of intensive therapy on serum fibrinogen and lipid levels, compared with standard treatment. Methods: 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. Results: 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 19325 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 highdensity 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. Conclusions: 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.",
author = "Nicholas Emanuele and Nasrin Azad and Carlos Abraira and William Henderson and John Colwell and Seymour Levin and Frank Nuttall and John Comstock and Clark Sawin and Cynthia Silbert and Santica Marcovina and Lee, {Hae Sook}",
year = "1998",
month = "12",
day = "7",
language = "English",
volume = "158",
pages = "2485--2490",
journal = "JAMA Internal Medicine",
issn = "2168-6106",
publisher = "American Medical Association",
number = "22",

}

TY - JOUR

T1 - Effect of intensive glycemic control on fibrinogen, lipids, and lipoproteins

T2 - Veterans Affairs Cooperative Study in Type II Diabetes Mellitus

AU - Emanuele, Nicholas

AU - Azad, Nasrin

AU - Abraira, Carlos

AU - Henderson, William

AU - Colwell, John

AU - Levin, Seymour

AU - Nuttall, Frank

AU - Comstock, John

AU - Sawin, Clark

AU - Silbert, Cynthia

AU - Marcovina, Santica

AU - Lee, Hae Sook

PY - 1998/12/7

Y1 - 1998/12/7

N2 - Background: 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. Objective: To assess the effect of intensive therapy on serum fibrinogen and lipid levels, compared with standard treatment. Methods: 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. Results: 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 19325 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 highdensity 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. Conclusions: 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.

AB - Background: 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. Objective: To assess the effect of intensive therapy on serum fibrinogen and lipid levels, compared with standard treatment. Methods: 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. Results: 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 19325 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 highdensity 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. Conclusions: 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.

UR - http://www.scopus.com/inward/record.url?scp=0032556644&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032556644&partnerID=8YFLogxK

M3 - Article

C2 - 9855387

AN - SCOPUS:0032556644

VL - 158

SP - 2485

EP - 2490

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

SN - 2168-6106

IS - 22

ER -