Diabetes Care：甘精胰岛素轻度降低动脉粥样硬化风险

　　对于心血管疾病患者和/或糖代谢障碍伴心血管事件风险者，甘精胰岛素治疗可使患者血糖水平恢复正常，并轻度延缓颈动脉内膜中层厚度（CIMT）增加，而每日补充n-3多不饱和脂肪酸（n-3FA）则无此效果。2013年4月5日在线发表于《糖尿病护理》的一项研究得出上述结论。

　　研究采用随机多中心2 × 2析因设计，共纳入1184例罹患心血管疾病或存在心血管风险的患者，所有患者均伴发空腹血糖受损（IFG）、糖耐量异常或合并早期2型糖尿病。受试者接受甘精胰岛素治疗（目标为空腹血糖水平≤5.3 mmol/L [95 mg/dL]）或标准降糖干预，全程双盲服用1g n-3FA或安慰剂。

　　研究主要终点为颈总动脉、颈动脉分叉部以及内颈动脉部所有部位CIMT年变化率。次级终点为颈总动脉、颈总动脉+分叉部CIMT年均最大增加率。由基线始每年行超声检查，中位随访时间4.9年。

　　主要终点结果，甘精胰岛素组与标准治疗组相比可减轻CIMT，但差异无统计学意义（P = 0.145）；次级终点两组差异明显（颈总动脉CIMT差异0.0033 ± 0.0017 mm/年[P = 0.049]，颈总动脉+分叉部CIMT差异0.0045 ± 0.0021 mm/年[P = 0.032]）。 

与抑郁相关的拓展阅读：

• EPA 2013：正念治疗可减少TBI的抑郁症状
• BJP:快速循环型双相障碍可用抗抑郁药？
• J Am Heart Assoc：抑郁让猝死风险加倍
• Eur J Endocrinol:抑郁与1型糖尿病血糖控制不佳相关
• JACC：左室辅助装置改善终末心衰患者的抑郁和焦虑
• Clin J Pain：以疼痛患者的精神挫败感为治疗标靶可预防抑郁症
  
• 更多信息请点击：有关抑郁更多资讯

Effect of Insulin Glargine and n-3FA on Carotid Intima-Media Thickness in People With Dysglycemia at High Risk for Cardiovascular Events
The Glucose Reduction and Atherosclerosis Continuing Evaluation Study (ORIGIN-GRACE)
OBJECTIVES
To evaluate the effects of insulin glargine and n-3 polyunsaturated fatty acid (n-3FA) supplements on carotid intima-media thickness (CIMT).
RESEARCH DESIGN AND METHODS
We enrolled 1,184 people with cardiovascular (CV) disease and/or CV risk factors plus impaired fasting glucose, impaired glucose tolerance, or early type 2 diabetes in a randomized multicenter 2 × 2 factorial design trial. Participants received open-label insulin glargine (targeting fasting glucose levels ≤5.3 mmol/L [95 mg/dL]) or standard glycemic care and double-blind therapy with a 1-g capsule of n-3FA or placebo. The primary trial outcome was the annualized rate of change in maximum CIMT for the common carotid, bifurcation, and internal carotid artery segments. Secondary outcomes were the annualized rates of change in maximum CIMT for the common carotid and the common carotid plus bifurcation, respectively. Baseline followed by annual ultrasounds were obtained during a median follow-up of 4.9 years.
RESULTS
Compared with standard care, insulin glargine reduced the primary CIMT outcome, but the difference was not statistically significant (difference = 0.0030 ± 0.0021 mm/year; P = 0.145) and significantly reduced the secondary CIMT outcomes (differences of 0.0033 ± 0.0017 mm/year [P = 0.049] and 0.0045 ± 0.0021 mm/year [P = 0.032], respectively). There were no differences in the primary and secondary outcomes between the n-3FA supplement and placebo groups.
CONCLUSIONS
In people with CV disease and/or CV risk factors and dysglycemia, insulin glargine used to target normoglycemia modestly reduced CIMT progression, whereas daily supplementation with n-3FA had no effect on CIMT progression.