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DOI: 10.2337/diabetes.55.02.06.db05-1023
© 2006 by the American Diabetes Association
Pharmacology and Therapeutics |
Insulin Improves Myocardial Blood Flow in Patients With Type 2 Diabetes and Coronary Artery Disease
1 Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
2 Department of Medicine, University of Turku and Turku University Hospital, Turku, Finland
3 Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
Address correspondence and reprint requests to Dr. Riikka Lautamäki, Turku PET Centre, Turku University Hospital, P.O. Box 52, FIN-20521, Turku, Finland. E-mail: rimala{at}utu.fi
Key Words: CAD, coronary artery disease • GIK, glucose-insulin-potassium • MBF, myocardial blood flow • PET, positron emission tomography • ROI, region of interest • SPECT, single-photon emission–computed tomography
Insulin infusion improves myocardial blood flow (MBF) in healthy subjects. Until now, the effect of insulin on myocardial perfusion in type 2 diabetic subjects with coronary artery disease (CAD) has been unknown. We studied the effects of insulin on MBF in ischemic regions evaluated by single-photon emission–computed tomography and coronary angiography and in nonischemic regions in 43 subjects (ages 63 ± 7 years) with type 2 diabetes (HbA1c 7.1 ± 0.9%). MBF was measured at fasting and during a euglycemic-hyperinsulinemic clamp at rest (n = 43) and during adenosine-induced (140 µg · kg–1 · min–1 for 7 min) hyperemia (n = 26) using positron emission tomography and 15O-labeled water. MBF was significantly attenuated in ischemic regions as compared with in nonischemic regions (P < 0.0001) and was increased by insulin as compared with in the fasting state (P < 0.0001). At rest, insulin infusion increased MBF by 13% in ischemic regions (P = 0.043) and 22% in nonischemic regions (P = 0.003). During adenosine infusion, insulin enhanced MBF by 20% (P = 0.018) in ischemic regions and 18% (P = 0.045) in nonischemic regions. In conclusion, insulin infusion improved MBF similarly in ischemic and nonischemic regions in type 2 diabetic subjects with CAD. Consequently, in addition to its metabolic effects, insulin infusion may improve endothelial function and thus increase the threshold for ischemia and partly contribute to the beneficial effects found in clinical trials in these subjects.
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