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Indian J Med Sci ; 2009 Apr; 63(4): 131-8
Artigo em Inglês | IMSEAR | ID: sea-68984

RESUMO

Background : The role of endothelial injury and circulating adhesion molecule in the development and progression of diabetic peripheral neuropathy in the long-term has been established previously. Aims:0 To study the effects of short-term glycemic control using insulin and oral hypoglycemic agent therapy (OHA) on the peroneal nerve function and vascular cell adhesion molecule-1 (VCAM-1) and advanced glycation endproducts (AGE) levels in type 2 diabetic patients. Settings and Design : A randomized controlled study involving poorly controlled (HbA1c, 7.5%-11%) type 2 diabetic patients attending the endocrinology outpatient center in a tertiary hospital in Kuala Lumpur. Materials and Methods Twenty-nine patients were randomized to receive insulin (n=15) or OHA (n=14) for 8 weeks. The glycemic variables (HbA1c, fasting plasma glucose [FPG], fructosamine), VCAM-1, serum AGE and the peroneal motor conduction velocity (PMCV) were measured at baseline and at 4-week intervals. Statistical Analysis Used : Paired 't' test or Kruskal Wallis test; and the unpaired 't' test or Mann-Whitney U test were used for within-group and between-group analyses, respectively. Correlation was analyzed using Spearman's correlation coefficient. Results : Within-group analysis showed significant progressive improvement in HbA1c at weeks 4 and 8 in the insulin group. The PMCV improved significantly in both groups by week 8, and by week 4 (P = 0.01) in the insulin group. PMCV correlated negatively with VCAM-1 (P = 0.031) and AGE (P = 0.009) at week 8. Conclusion : Aggressive glycemic control with insulin improves the peroneal nerve function within 4 weeks. Improvement in the serum VCAM-1 and AGE levels correlated significantly with improvement in peroneal nerve conduction velocity only in the insulin group.


Assuntos
Administração Oral , Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/complicações , Neuropatias Diabéticas/tratamento farmacológico , Neuropatias Diabéticas/etiologia , Feminino , /sangue , Hemoglobinas Glicadas/efeitos dos fármacos , Humanos , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Malásia , Masculino , Pessoa de Meia-Idade , Condução Nervosa/efeitos dos fármacos , Nervo Fibular/efeitos dos fármacos , Neuropatias Fibulares/tratamento farmacológico , Neuropatias Fibulares/etiologia , Fatores de Tempo , Molécula 1 de Adesão de Célula Vascular/efeitos dos fármacos
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