부산대학교 도서관

Background: Myocardial stress, as measured by N-terminal pro-B-type natriuretic peptide (NT-proBNP), is related to glycemic control in patients with type 2 diabetes (T2D), and is a strong predictor of adverse cardiovascular outcome. Our objective was to determine, in a randomized fashion, whether anti-hyperglycemic therapy improves myocardial stress in patients with T2D.Methods: We randomized, in a 2x2 factorial fashion, 438 patients with T2D to insulin glargine, metformin, the combination, or placebo and measured changes in NT-proBNP after 12 weeks of therapy. The primary comparison was insulin vs. no insulin and metformin vs. no metformin.Results: At baseline, the median (Q1-Q3) NT-proBNP plasma concentration was 35.4 (15.7-86.3) ng/l and did not differ by randomized treatment group (p=0.40). The adjusted (95% CI) change in NT-proBNP concentration was 20.7% (7.9 to 35.0) in the insulin arm compared with 0.2% (-10.8 to 12.5) in the no-insulin arm (P=0.03 for comparison). In the metformin arm, the adjusted change in NT-proBNP was 7.8% (-3.7 to 20.7) compared with 13.0% (0.72 to 26.8) in the no-metformin arm (P=0.58). The changes in the insulin arm were not related to changes in fasting or post-prandial glucose, hemoglobin A1c, weight, blood pressure, or inflammation.Conclusion: After 12 weeks of therapy, insulin glargine was associated with a significant 20.7% increase in NT-proBNP, a marker of myocardial stress. The change was independent of substantial improvements in glucose control.