Hypothesis:Intensive insulin therapy-induced mortality is due to excessive serotonin autoinhibition and autonomic dysregulation  

作　　者：Undurti N Das 

机构地区：[1]Jawaharlal Nehru Technological University [2]UND Life Sciences,Shaker Heights

出　　处：《World Journal of Diabetes》2010年第4期101-108,共8页世界糖尿病杂志（英文版）（电子版）

基　　金：Supported by Department of Biotechnology,India

摘　　要：Action to Control Cardiovascular Risk in Diabetes(ACCORD),The Action in Diabetes and Vascular Disease:Preterax and Diamicron Modified Release Controlled Evaluation and the Veterans Affairs Diabetes Trial were designed to study whether older patients with type 2 diabetes mellitus could reduce the risk of heart attacks and stroke and thereby prolong their lives by maintaining their blood glucose levels at near-healthy levels but failed to demonstrate the hoped-for benef it.Why the trials failed,though,and why ACCORD saw significantly more deaths due to increased rates of cardiovascular events in the intensive therapy arm of the study are not clear.These data have now been confirmed by the results of the recently concluded NICE-SUGAR Study which again revealed that intensive gluc ose control increased mortality among adults in intensive care units.I propose that the negative results noted in these trials are due to altered brain serot o nin concentrations and autonomic dysregulation in addition to the low-grade systemic inflammation,decreased endothelial nitric oxide and enhanced free radical generation,diminished anti-oxidant defenses and altered metabol ism of essential fatty acids present in patients with type 2 diabetes.Action to Control Cardiovascular Risk in Diabetes(ACCORD),The Action in Diabetes and Vascular Disease:Preterax and Diamicron Modified Release Controlled Evaluation and the Veterans Affairs Diabetes Trial were designed to study whether older patients with type 2 diabetes mellitus could reduce the risk of heart attacks and stroke and thereby prolong their lives by maintaining their blood glucose levels at near-healthy levels but failed to demonstrate the hoped-for benef it.Why the trials failed,though,and why ACCORD saw significantly more deaths due to increased rates of cardiovascular events in the intensive therapy arm of the study are not clear.These data have now been confirmed by the results of the recently concluded NICE-SUGAR Study which again revealed that intensive gluc ose control increased mortality among adults in intensive care units.I propose that the negative results noted in these trials are due to altered brain serot o nin concentrations and autonomic dysregulation in addition to the low-grade systemic inflammation,decreased endothelial nitric oxide and enhanced free radical generation,diminished anti-oxidant defenses and altered metabol ism of essential fatty acids present in patients with type 2 diabetes.

关 键 词：Type 2 diabetes mellitus Cardiovascular events Coronary heart disease Stroke DYSLIPIDEMIA Essential fatty acids NITRIC oxide Free RADICALS Antioxidants Insulin 

分 类 号：R587.1[医药卫生—内分泌]