Two years of intensive glycemic control and left ventricular function in the veterans affairs cooperative study in type 2 diabetes mellitus (VA CSDM)

OBJECTIVE - The Veterans Affairs Cooperative Study in Type 2 Diabetes Mellitus (VA CSDM) was a multicenter randomized prospective study of 153 male type 2 diabetic patients to assess the ability to sustain clinically significant glycemic separation between intensive and standard treatment arms. A trend toward an excess of combined cardiovascular events in the intensive treatment arm of this trial was reported earlier. The present analysis was done to evaluate the effect of 2 years of intensive glycemic control on the left ventricular (LV) function. RESEARCH DESIGN AND METHODS - The patients were randomized to intensive step treatment with insulin alone or with sulfonylurea (intensive treatment arm [INT], n = 75) or to standard once-daily insulin injection (standard treatment arm [STD], n = 78) treatment. A total of 136 patients (standard treatment arm [STD], n = 70; INT, n = 66) had radionuclide ventriculography at entry and at 24 months for the assessment of LV function. RESULTS - There was no difference in the mean LV ejection fraction (at entry: STD 57.1 ± 9.51%; INT 58.1 ± 8.7%; at 24 months: STD 57.3 ± 10.8%, INT 59.5 ± 10.7%), peak filling rate (at entry: STD 2.6 ± 0.7 end diastolic volume per second, INT 2.4 ± 0.8 end diastolic volume per second; at 24 months: STD 2.7 ± 1.0 end diastolic volume per second, INT 2.5 ± 0.7 end diastolic volume per second), or time to peak filling rate (at entry: STD 195.3 ± 69.5 ms, INT 185.6 ± 62.4 ms; at 24 months: STD 182.6 ± 64.8 ms, INT 179.2 ± 61.2 ms) between the 2 treatment arms. A subgroup analysis of 104 patients (STD, n = 53; INT, n = 51) that omitted individuals with intervening cardiac events/revascularization or a change in cardioactive medications also showed no difference in the LV function at entry and at 24 months between the 2 groups. Abnormal LV ejection fraction at baseline predicted cardiac events (interval between cardiac beats [RR] = 2.5). CONCLUSIONS Two years of intensive glycemic control does not affect the LV systolic or diastolic function in patients with type 2 diabetes.