Abstract 13499: Effects of Life-style Intervention on the Coronary Atherosclerosis in Early-stage Diabetic Patients: a Comparison with Voglibose and Nateglinide - A study of the DIAbetes and diffuse coronary Narrowing (DIANA) -
Backgrounds: Recent prospective randomized trials showed limited effects of anti-diabetic drug on cardiovascular events in advanced diabetic patients. However, it remains unknown whether life-style intervention (LI) or pharmacological intervention specifically targeting postprandial hyperglycemia prevents coronary atherosclerosis in the early-stage diabetic patients with CAD.
Methods: The DIAbetes and diffuse coronary NArrowing (DIANA) study is a prospective randomized open-label multi-center trial to investigate the efficacy of LI, Voglibose (an inhibitor of carbohydrates absorption) and Nateglinide (a stimulator of insulin secretion) on the changes of coronary atherosclerosis in Japanese early-stage diabetic patients with CAD. A total of 302 patients with both CAD and IGT or DM pattern by 75g-OGTT and HbA1c level lower than 6.5 % were randomly assigned to LI (n=101), Voglibose treatment (0.9mg/day, n=100) or Nateglinide treatment (180mg/day, n=101). Coronary atherosclerotic changes were examined by our invented angiographic indexes using quantitative coronary angiography.
Results: Although Voglibose resulted in a significant increase in normal glucose tolerance and Nateglinide significantly reduced HbA1c level, other metabolic profiles including PPG, insulin sensitivity, adiponectin and hs-CRP levels were changed similarly at one year after randomization among three groups. After one-year of the follow-up period, significant progression of coronary atherosclerosis was not observed in LI group and this efficacy was equivalent to the other 2 groups.
Conclusion: These findings indicate that pharmacological intervention targeting with PPG had no additional beneficial changes in coronary atherosclerosis beyond LI in Japanese early-stage diabetic patients during one-year of the intervention period.
- © 2010 by American Heart Association, Inc.