Metabolic and sympathovagal effects of bolus insulin glulisine versus basal insulin glargine therapy in people with type 2 diabetes: A randomized controlled study
Abstract Aims/Introduction This study compares the effects of two different insulin regimens – basal versus bolus insulin – on metabolic and cardiovascular autonomic function in Japanese participants with type 2 diabetes. Materials and Methods Participants were randomly assigned to groups for therap...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-07-01
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| Series: | Journal of Diabetes Investigation |
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| Online Access: | https://doi.org/10.1111/jdi.13471 |
| _version_ | 1823941219380625408 |
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| author | Yumie Takeshita Takeo Tanaka Hitomi Wakakuri Yuki Kita Takehiro Kanamori Toshinari Takamura |
| author_facet | Yumie Takeshita Takeo Tanaka Hitomi Wakakuri Yuki Kita Takehiro Kanamori Toshinari Takamura |
| author_sort | Yumie Takeshita |
| collection | DOAJ |
| description | Abstract Aims/Introduction This study compares the effects of two different insulin regimens – basal versus bolus insulin – on metabolic and cardiovascular autonomic function in Japanese participants with type 2 diabetes. Materials and Methods Participants were randomly assigned to groups for therapy with insulin glulisine (IGlu) or insulin glargine (IGla). The primary efficacy end‐point was glycemic variability, including M‐values, mean of glucose levels, and a blood glucose profile of seven time points before and after the intervention. The secondary end‐points included pleiotropic effects, including endothelial and cardiac autonomic nerve functions. Results Blood glucose levels at all time points significantly decreased in both groups. Post‐lunch, post‐dinner, and bedtime blood glucose levels were significantly lower in the IGlu group than in the IGla group. Nadir fasting blood glucose levels at the end‐point were significantly lower in the IGla group than in the IGlu group. The M‐value and mean blood glucose levels were significantly decreased from baseline in both groups, although the former was significantly lower in the IGlu group than in the IGla group. IGla, but not IGlu, was found to elevate 24‐h parasympathetic tone, especially during night‐time, and it decreased 24‐h sympathetic nerve activity, especially at dawn. Conclusions Both IGlu and IGla regimens reduced glucose variability, with IGlu bringing a greater reduction in M‐value. IGla, but not IGlu, increased parasympathetic tone during night‐time and decreased sympathetic nerve activity at dawn. These findings shed light on the previously unrecognized role of night‐time basal insulin supplementation on sympathovagal activity in type 2 diabetes patients. |
| first_indexed | 2024-12-17T04:24:26Z |
| format | Article |
| id | doaj.art-b92b3bf1d58b433baac98da2c62214a7 |
| institution | Directory Open Access Journal |
| issn | 2040-1116 2040-1124 |
| language | English |
| last_indexed | 2024-12-17T04:24:26Z |
| publishDate | 2021-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Diabetes Investigation |
| spelling | doaj.art-b92b3bf1d58b433baac98da2c62214a72022-12-21T22:03:44ZengWileyJournal of Diabetes Investigation2040-11162040-11242021-07-011271193120110.1111/jdi.13471Metabolic and sympathovagal effects of bolus insulin glulisine versus basal insulin glargine therapy in people with type 2 diabetes: A randomized controlled studyYumie Takeshita0Takeo Tanaka1Hitomi Wakakuri2Yuki Kita3Takehiro Kanamori4Toshinari Takamura5Department of Endocrinology and Metabolism Kanazawa University Graduate School of Medical Sciences Kanazawa Ishikawa JapanDepartment of Endocrinology and Metabolism Kanazawa University Graduate School of Medical Sciences Kanazawa Ishikawa JapanDepartment of Endocrinology and Metabolism Kanazawa University Graduate School of Medical Sciences Kanazawa Ishikawa JapanDepartment of Endocrinology and Metabolism Kanazawa University Graduate School of Medical Sciences Kanazawa Ishikawa JapanDepartment of Endocrinology and Metabolism Kanazawa University Graduate School of Medical Sciences Kanazawa Ishikawa JapanDepartment of Endocrinology and Metabolism Kanazawa University Graduate School of Medical Sciences Kanazawa Ishikawa JapanAbstract Aims/Introduction This study compares the effects of two different insulin regimens – basal versus bolus insulin – on metabolic and cardiovascular autonomic function in Japanese participants with type 2 diabetes. Materials and Methods Participants were randomly assigned to groups for therapy with insulin glulisine (IGlu) or insulin glargine (IGla). The primary efficacy end‐point was glycemic variability, including M‐values, mean of glucose levels, and a blood glucose profile of seven time points before and after the intervention. The secondary end‐points included pleiotropic effects, including endothelial and cardiac autonomic nerve functions. Results Blood glucose levels at all time points significantly decreased in both groups. Post‐lunch, post‐dinner, and bedtime blood glucose levels were significantly lower in the IGlu group than in the IGla group. Nadir fasting blood glucose levels at the end‐point were significantly lower in the IGla group than in the IGlu group. The M‐value and mean blood glucose levels were significantly decreased from baseline in both groups, although the former was significantly lower in the IGlu group than in the IGla group. IGla, but not IGlu, was found to elevate 24‐h parasympathetic tone, especially during night‐time, and it decreased 24‐h sympathetic nerve activity, especially at dawn. Conclusions Both IGlu and IGla regimens reduced glucose variability, with IGlu bringing a greater reduction in M‐value. IGla, but not IGlu, increased parasympathetic tone during night‐time and decreased sympathetic nerve activity at dawn. These findings shed light on the previously unrecognized role of night‐time basal insulin supplementation on sympathovagal activity in type 2 diabetes patients.https://doi.org/10.1111/jdi.13471Glycemic variabilityInsulin therapySympathovagal effects |
| spellingShingle | Yumie Takeshita Takeo Tanaka Hitomi Wakakuri Yuki Kita Takehiro Kanamori Toshinari Takamura Metabolic and sympathovagal effects of bolus insulin glulisine versus basal insulin glargine therapy in people with type 2 diabetes: A randomized controlled study Journal of Diabetes Investigation Glycemic variability Insulin therapy Sympathovagal effects |
| title | Metabolic and sympathovagal effects of bolus insulin glulisine versus basal insulin glargine therapy in people with type 2 diabetes: A randomized controlled study |
| title_full | Metabolic and sympathovagal effects of bolus insulin glulisine versus basal insulin glargine therapy in people with type 2 diabetes: A randomized controlled study |
| title_fullStr | Metabolic and sympathovagal effects of bolus insulin glulisine versus basal insulin glargine therapy in people with type 2 diabetes: A randomized controlled study |
| title_full_unstemmed | Metabolic and sympathovagal effects of bolus insulin glulisine versus basal insulin glargine therapy in people with type 2 diabetes: A randomized controlled study |
| title_short | Metabolic and sympathovagal effects of bolus insulin glulisine versus basal insulin glargine therapy in people with type 2 diabetes: A randomized controlled study |
| title_sort | metabolic and sympathovagal effects of bolus insulin glulisine versus basal insulin glargine therapy in people with type 2 diabetes a randomized controlled study |
| topic | Glycemic variability Insulin therapy Sympathovagal effects |
| url | https://doi.org/10.1111/jdi.13471 |
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