[Effect of insulin therapy on insulin resistance and risk for ischemic heart disease and death from cardiovascular pathology in patients with diabetes mellitus, type 2].

Aim: To evaluate the impact of insulin therapy in combination with oral sugar-reducing drugs (OSRD) on metabolic control and a risk for coronary heart disease (CHD) and a 10-year cardiovascular death risk in patients with type 2 diabetes (T2D).

Subjects And Methods: Seventy-four patients (49 women and 25 men) aged 36-78 years (mean 56.28 +/- 2.58 years) with a 9.34 +/- 1.12-year history of T2D were examined. The investigators made a clinical examination, studied the parameters of carbohydrate metabolism: glycated hemoglobin (HbA1c), fasting (FG) and postprandial glycemia (PPG) (2 hours after meals) and lipid metabolism, insulin resistance, microalbuminuria (MAU), and combined therapy-induced blood pressure changes. The risk for CHD was estimated from the atherogenicity index, total cholesterol/high-density lipoproteins and low-density lipoproteins/high-density lipoproteins ratios, and SCORE index.

Results: Long-term insulin therapy in combination with OSRD caused a significant improvement in carbohydrate metabolism (reductions in HbA1c by 21.6-23.2%, FG and PPG by 33.4-35.7%), positive lipid metabolic changes, a decrease in MAU by 0.12 +/- 0.03 to 0.03 +/- 0.01 g/l, with a fall of its detection rate from 73 to 27%; a considerable decline in IR from the HOMA and CARO indices (by 30-32%), as well as a significant reduction in the risk for CHD and 10-year cardiovascular death risk from the SCORE index (from 4 to 1.5-1.6%; p < 0.01).

Conclusion: Combined therapy with long-acting insulin in combination with OSRD in patients with T2D resulted in metabolic improvement and a significant reduction in the risk for CHD and 10-year cardiovascular death risk.