Proceedings of The 3rd Africa Diabetes Congress, Yaounde, Cameroon (Yaounde, 2017)

Oral presentation

The effect of optimizing glycemic control using insulin on the heart rate variability in type 2 diabetes mellitus patients

Cite this: Pan African Medical Journal - Conference Proceedings. Sep 2017; 2(2): 20. doi:10.11604/pamj.cp.2017.2.20.50

Submitted: 31 Aug 17   Accepted: 31 Aug 17   Published: 04 Sep 17

Key words: Type 2 diabetes mellitus, HRV, glycemic control, insulin

© Camille Berjauline Mba Maadjhou et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.proceedings.panafrican-med-journal.com/conferences/2017/2/20/abstract

Corresponding author: (camilya91@yahoo.fr)

This abstract is published as part of the proceedings of The 3rd Africa Diabetes Congress, Yaounde, Cameroon(CAMEROON, )

Untitled Document

The effect of optimizing glycemic control using insulin on the heart rate variability in type 2 diabetes mellitus patients

Camille Berjauline Mba Maadjhou1,&, Chris Nadege Nganou-Gnindjio2, Marcel Azabji-Kenfack2, Liliane Mfeukeu Kuate3, Andre Michel Bimbai4, Jean-Claude Njabou Katte2, Eugene Sobngwi2

 

1Ecole Doctorale, Université de Yaoundé 1, Yaoundé, Cameroun, 2Faculté de Médecine et de Science Biomédicale, Université de Yaoundé 1, Cameroun, 3Hôpital Central de Yaoundé, Yaoundé, Cameroon, 4HOPIT, Cameroun

 

 

&Corresponding author
Camille Berjauline Mba Maadjhou, Ecole Doctorale, Université de Yaoundé 1, Yaoundé, Cameroun

 

 

Abstract

Introduction: diabetes mellitus is a metabolic disorder associated with several complications. Among the microvascular complications, cardiovascular autonomic neuropathy (CAN) is the most important autonomic neuropathy due to its potential life threatening outcome, especially in poorly controlled patients. Heart rate variability (HRV) provides a non-invasive tool for exploring the autonomic nervous system. Intensive glycemic control prevents the development of CAN in patients with type 1 diabetes. On the other side, whether the intensification of glycemic control using insulin will improve cardiovascular autonomic functions in patients with type 2 diabetes mellitus is uncertain. Our main objective was to determine the effect of optimizing glycemic control using insulin on the heart rate variability in type 2 diabetes mellitus patients.

 

Methods: to determine this, we conducted a non-randomized single arm clinical trial study at the National Obesity Centre of the Yaoundé Central Hospital. Participants were poorly controlled type 2 diabetes mellitus patients (glycated hemoglobin ≥ 7%) which constituted the intervention group and well controlled patients (glycated hemoglobin < 7%). The intervention lasted 60 days and consisted in the intensification of blood glucose control through the initiation of a basal plus insulin regimen with titration of insulin to protocol defined blood glucose targets which are; fasting blood glucose: 70-130mg/dl and post prandial blood glucose < 180mg/dl. The primary outcome measure was a change in HRV parameters and the secondary outcome measures a change in glycated hemoglobin, glycemia and weight. Results were analyzed as treated.

 

Results: in total, 54 consenting type 2 diabetes mellitus patients without clinical signs of CAN were recruited (26 males and 28 females). The median age was 56(43-62) years, and duration of diabetes 3(1-7) years. The intervention was carried out on 29 poorly controlled patients, compared at baseline to 25 well controlled patients who had been matched for age sex and body mass index. Markers of sympathetic tone were lower and thus altered in the poorly controlled group (SDNN: 102.01(90.45-111.05)msvs 112.30(104.40-131.15)ms, p = 0.014 and SDANN 88.01(72.95-99.70)msvs 97.80(91.80-114.50)ms, p = 0.012). The intervention induced a change in HbA1c from 10.1(9.1-11.9)% to 6.7[5.9-6.9]% (p < 0.001). Concerning HRV analysis, there was a significant increase in markers of the parasympathetic (PNN50: 5.70[3.55-10.25]% to 8.12(3.05-16.90)%, p = 0.008) and sympathetic activities (SDNN: 102.01(90.45-111.05)ms to 122.40(91.70-135.95)ms, p = 0.01).

 

Conclusion: the optimization of glycemic control using a basal plus insulin regimen while inducing a significant reduction in glycated hemoglobin, significantly improves HRV parameters representing the sympathetic and parasympathetic activities. This suggests that tight glycemic control using insulin may improve cardiovascular autonomic functions in type 2 diabetes mellitus patients.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The 3rd Africa Diabetes Congress, Yaounde, Cameroon (Yaounde)

Country: CAMEROON

Dates: 19 Apr 17 - 22 Apr 17

Venue: Yaounde Congress Hall

Organizers: Africa Diabetes Congress Limited

Secretariat: secretariat@africadiabetescongress.com

Contact person: Prof. Jean Claude Mbanya (jcmbanya@yahoo.co.uk)