Key result
Insulin added to metformin for 4 weeks improved myocardial perfusion, decreased peripheral arterial stiffness, and increased post-prandial diastole duration in patients with type 2 diabetes.
Why the study?
It was hypothesized that adding long-acting, fast-acting, or basal bolus insulin to metformin in patients with type 2 diabetes would provide additional improvement in arterial stiffness.
Does insulin treatment added to metformin improve arterial stiffness and diastole duration in patients with type 2 diabetes failing oral therapy?
RCT (n=42)
open label
randomized
Does insulin treatment added to metformin improve arterial stiffness and diastole duration in patients with type 2 diabetes failing oral therapy?
Short-term addition of insulin to metformin in type 2 diabetes patients failing oral therapy improves arterial stiffness and myocardial perfusion parameters.
Supports short-term insulin addition in metformin-failing T2D; extends RCT evidence to perfusion and stiffness endpoints.
BACKGROUND: Fast acting insulin analogues are known to improve arterial stiffness. The combination of metformin with insulin represents a widely used therapeutic strategy in diabetes. We hypothesized that insulin treatment in patients with type 2 diabetes (T2D) with long-acting, fast-acting or basal bolus insulin as an add-on to metformin would provide additional improvement of arterial stiffness. METHODS: The INSUlin Regimens and VASCular Functions (INSUVASC) study is a pilot, randomized, open label three-arms study that included 42 patients with type 2 diabetes (T2D) in primary prevention, after a failure to oral antidiabetic agents. Arterial stiffness measurements were performed at fasting and after a standardized breakfast. During the first visit (V1) pre-randomization, participants took only metformin to perform the tests. The same tests were repeated after 4 weeks of insulin treatment during the second visit (V2). RESULTS: Data were available for final analysis in 40 patients, with a mean age of 53.6±9.7 years and a mean duration of diabetes of 10.6±5.6 years. Twenty-one were females (52.5%), hypertension and dyslipidemia were present in 18 (45%) and 17 patients (42.5%), respectively. After insulin treatment, the metabolic control was associated to a decrease in oxidative stress and improvement of endothelial functions, with a post prandial diastole duration increased and a decrease of the peripheral arterial stiffness, with a better post prandial pulse pressure ratio and ejection duration after insulin. In hypertensive patients, insulin treatment provided positive effects by decreasing the pulse wave velocity and improving reflection time. CONCLUSIONS: A short time treatment by insulin in addition to metformin improved myocardial perfusion. Moreover, insulin treatment in hypertensive patients provides a better hemodynamic profile in large arteries.
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Fysekidis et al. (2023) conducted an RCT in Type 2 diabetes (n=42). Insulin as an add-on to metformin vs. Metformin alone (baseline) was evaluated on Arterial stiffness and endothelial function. Insulin added to metformin for 4 weeks improved myocardial perfusion, decreased peripheral arterial stiffness, and increased post-prandial diastole duration in patients with type 2 diabetes.
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