Insulin therapy improves insulin actions on glucose metabolism and aortic wave reflection in type 2 diabetic patients

BACKGROUND: Normal insulin action in vivo involves a decrease in aortic systolic blood pressure as a result of an insulin-induced decrease in the amplitude of the second systolic (reflected) pressure wave. This action of insulin and insulin action on glucose metabolism is impaired in insulin-resistant and type 2 diabetic subjects. We determined whether 6 months of insulin therapy affects insulin actions on glucose metabolism and vascular function. MATERIALS AND METHODS: Thirteen type 2 diabetic patients (age 53 +/- 2 years, body mass index 30.8 +/- 1.2 kg m(-2), HbA1C 8.8 +/- 0.2%) were studied before and after insulin therapy. Central aortic pressure waveforms were reconstructed from those recorded in the periphery using applanation tonometry every 30 min. This allowed determination of augmentation, i.e. the pressure difference between the second and first systolic pressure peaks and the augmentation index (AgI, augmentation divided by pulse pressure). The measurements were performed basally and during euglycaemic hyperinsulinaemic conditions. RESULTS: Insulin therapy increased whole body glucose disposal by 35% from 5.1 +/- 0.7 to 6.8 +/- 0.6 mg kg ffm(-1) min(-1) (P<0.001 for 0 vs. 60 months). 6 months of insulin therapy decreased basal AgI from 26.2 +/- 1.8 to 22.7 +/- 2.3% (P<0.05). The change in AgI by insulin infusion was similar before and after insulin therapy at all time points. Peripheral blood flow, heart rate and blood pressures remained unchanged. CONCLUSIONS: Insulin therapy improves insulin action on glucose metabolism and decreases basal AgI. These data support the idea that insulin therapy has beneficial effects on vascular function.