Atherosclerosis associated with dynamic inflammation changes after multifactorial intervention in short-duration type 2 diabetes: A randomized, controlled, 10-year follow-up trial

作者：Shi, Chunhong; Men, Lili; Yu, Cuiping; Yao, Junjie; Bai, Ran; Yang, Yu; Sun, Lipeng; Sun, Guohua; Song, Guirong; Zhang, Yuhong; Xing, Qian; Du, Jianling^*

来源：Journal of Diabetes and Its Complications, 2017, 31(8): 1286-1292.

DOI：10.1016/j.jdiacomp.2017.05.008

• Type 2 diabetes
• Diabetes complications
• Atherosclerosis
• Multifactorial interventions
• Chronic inflammation

Purpose: To analyze the impact of dynamic changes in inflammation on atherosclerosis in short-duration type 2 diabetes after multifactorial intervention.
Methods: In this randomized controlled study, a total of 150 type 2 diabetes patients who had a mean age of 49.8 +/- 7.3 years, 51% male, with disease duration <1 year and without evidence of atherosclerosis were randomized into an intensive intervention group (IG), in which patients received multiple risk factors intervention by the special project team and tried to reach the pre-determined intervention goals, and a conventional group (CG), in which patients received standard diabetes care by the clinic doctor. All patients recieved intervention study for 7 years, then underwent a 3-year observational follow-up study. The primary endpoints were occurrence of subclinical atherosclerosis, defined as the intima-media thickness of the common carotid artery (CC-IMT) >= 1.0 mm or formation of atherosclerosis plaques, and the occurrence of cardiovascular events.
Results: 68 patients in IG and 65 patients in CG completed the 10-year study. The cumulative incidence of subclinical atherosclerosis was 30.7% vs 573% (IG vs CG, HR 036, 95% CI 022-0.60, P < 0.0001) and that of cardiovascular events was 12.0% vs 22.7% (IG vs CG, HR 0.46, 95% CI 021-0.98, P = 0.0516). High sensitivity C-reactive protein (hs-CRP) reduction from baseline to the 10-year follow-up was -1.54 mg/L (IG) and -0.67 mg/L (CG) with difference (IG minus CG) of -0.87 mg/L(95% CI -0.72 to -1.02, P = 0.008) and the natural logarithm of serum amyloid A (SAA) reduction was -4.04 (IG) and -1.44 (CG) with difference (IC minus CG) of -2.60 (95% CI -230 to -2.90, P = 0.002). The decrease in general score of inflammatory markers (combination of hs-CRP and SAA) was independently associated with subclinical atherosclerosis (OR = 0.65, P = 0.045) and cardiovascular events (OR = 0.60, P = 0.042).
Conclusions: Dynamic changes in inflammation act as an important factor that affects the occurrence of atherosclerosis in type 2 diabetes patients. Multifactorial intensive intervention can reduce systemic low-grade inflammation and delay the occurrence of atherosclerosis in short-duration type 2 diabetes.

• 出版日期2017-8
• 单位大连医科大学