Two years of intensive glycemic control and left ventricular function in the veterans affairs cooperative study in type 2 diabetes mellitus (VA CSDM)

S. U. Pitale, C. Abraira, N. V. Emanuele, M. McCarren, W. G. Henderson, I. Pacold, D. Bushnell, J. A. Colwell, F. Q. Nuttall, S. R. Levin, C. T. Sawin, J. P. Comstock, C. Silbert

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

OBJECTIVE - The Veterans Affairs Cooperative Study in Type 2 Diabetes Mellitus (VA CSDM) was a multicenter randomized prospective study of 153 male type 2 diabetic patients to assess the ability to sustain clinically significant glycemic separation between intensive and standard treatment arms. A trend toward an excess of combined cardiovascular events in the intensive treatment arm of this trial was reported earlier. The present analysis was done to evaluate the effect of 2 years of intensive glycemic control on the left ventricular (LV) function. RESEARCH DESIGN AND METHODS - The patients were randomized to intensive step treatment with insulin alone or with sulfonylurea (intensive treatment arm [INT], n = 75) or to standard once-daily insulin injection (standard treatment arm [STD], n = 78) treatment. A total of 136 patients (standard treatment arm [STD], n = 70; INT, n = 66) had radionuclide ventriculography at entry and at 24 months for the assessment of LV function. RESULTS - There was no difference in the mean LV ejection fraction (at entry: STD 57.1 ± 9.51%; INT 58.1 ± 8.7%; at 24 months: STD 57.3 ± 10.8%, INT 59.5 ± 10.7%), peak filling rate (at entry: STD 2.6 ± 0.7 end diastolic volume per second, INT 2.4 ± 0.8 end diastolic volume per second; at 24 months: STD 2.7 ± 1.0 end diastolic volume per second, INT 2.5 ± 0.7 end diastolic volume per second), or time to peak filling rate (at entry: STD 195.3 ± 69.5 ms, INT 185.6 ± 62.4 ms; at 24 months: STD 182.6 ± 64.8 ms, INT 179.2 ± 61.2 ms) between the 2 treatment arms. A subgroup analysis of 104 patients (STD, n = 53; INT, n = 51) that omitted individuals with intervening cardiac events/revascularization or a change in cardioactive medications also showed no difference in the LV function at entry and at 24 months between the 2 groups. Abnormal LV ejection fraction at baseline predicted cardiac events (interval between cardiac beats [RR] = 2.5). CONCLUSIONS Two years of intensive glycemic control does not affect the LV systolic or diastolic function in patients with type 2 diabetes.

Original languageEnglish (US)
Pages (from-to)1316-1320
Number of pages5
JournalDiabetes care
Volume23
Issue number9
DOIs
StatePublished - 2000

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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