Improvement of cardiovascular risk factors in patients with type 2 diabetes after long‐term continuous subcutaneous insulin infusion

Background The effects of long‐term continuous subcutaneous insulin infusion (CSII) on cardiovascular risk factors such as hyperglycaemia, dyslipidaemia, and proinflammatory cytokine levels have not been assessed so far in type 2 diabetes. Methods We analysed the levels of HbA 1c , serum lipids, tumor necrosis factor α (TNF‐α), and interleukin 6 (IL‐6) at 0, 2, and 30 weeks after CSII in 15 patients with type 2 diabetes (mean age, 53.3 ± 10.1 years; disease duration, 9.4 ± 5.3 years) without previous history of major cardiovascular events. Results At week 30, CSII significantly lowered HbA 1c by 5.0 ± 0.9% compared to baseline (7.9 ± 1.9%, p < 0.001) and improved high‐density lipoprotein cholesterol (HDLc; 1.09 ± 0.16 at baseline vs 1.25 ± 0.15 mmol/L at week 30; p < 0.05) and low‐density lipoprotein cholesterol (LDLc)/HDLc ratios (2.8 ± 1.4 at baseline vs 2.2 ± 0.9 at week 30; p < 0.05). CSII also decreased the proportion of patients with dyslipidaemia at week 30. At baseline, TNF‐α and IL‐6 levels were up‐regulated (2.65 ± 4.04 and 2.82 ± 1.81 pg/mL, respectively) compared to the normal control ( p < 0.01 and p < 0.05, respectively); however, cytokine levels decreased significantly at week 30 (1.44 ± 2.25 and 1.99 ± 1.05 pg/mL, respectively; p = NS vs control). Conclusions Long‐term CSII alone decreased cardiovascular risk factors in poorly controlled type 2 diabetes, suggesting that the synchronization of sufficient insulin peaks with meal ingestion and continuous pulsatile infusion of basal insulin corrects metabolic derangements. Copyright © 2008 John Wiley & Sons, Ltd.