The effects of short-term, rapid glycemic control on the peroneal nerve function and serum VCAM-1 and AGE in type 2 diabetic patients in Malaysia

Indian J Med Sci. 2009 Apr;63(4):131-8. doi: 10.4103/0019-5359.49365.

Abstract

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: 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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Blood Glucose / drug effects
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetic Neuropathies / blood
  • Diabetic Neuropathies / drug therapy*
  • Diabetic Neuropathies / etiology*
  • Female
  • Glycated Hemoglobin A / drug effects
  • Glycation End Products, Advanced / blood
  • Humans
  • Hypoglycemic Agents / administration & dosage
  • Injections, Subcutaneous
  • Insulin / administration & dosage
  • Malaysia
  • Male
  • Middle Aged
  • Neural Conduction / drug effects
  • Peroneal Nerve / drug effects
  • Peroneal Nerve / physiopathology
  • Peroneal Neuropathies / blood
  • Peroneal Neuropathies / drug therapy*
  • Peroneal Neuropathies / etiology*
  • Time Factors
  • Treatment Outcome
  • Vascular Cell Adhesion Molecule-1 / blood
  • Vascular Cell Adhesion Molecule-1 / drug effects

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Glycation End Products, Advanced
  • Hypoglycemic Agents
  • Insulin
  • Vascular Cell Adhesion Molecule-1