Issue 176 Item 9 Insulin Improves Exercise Performance in Diabetics With Heart F

Insulin therapy improves exercise ventilatory efficiency and oxygen uptake in heart failure patients with type 2 diabetes, new research by Italian investigators suggests.

Although a few reports have shown insulin to be beneficial in diabetics with heart disease, none have ever looked at the effect of insulin on exercise ventilatory efficiency and oxygen uptake, lead author Dr. Marco Guazzi and colleagues, from the University of Milan, note.

The current findings, are based on a crossover study of 18 patients with type 2 diabetes and heart failure. Various exercise respiratory parameters were measured after the patients were given an insulin or saline infusion.

At baseline, exercise ventilatory efficiency, oxygen uptake, and other parameters were compromised in the study group, the authors note. Sixty minutes after being given insulin, but not saline, an improvement in the two main parameters and others was noted. The benefits were still seen 6 hours after insulin infusion, but by 24 hours they had disappeared.

These improvements in exercise performance were not related to glycohemoglobin and baseline fasting blood sugar, the researchers point out.

The results indicate that "insulin causes a prolonged improvement in physical performance through activation of multiple factors, among which facilitation of gas conductance seems to be predominant," Dr. Guazzi’s team notes.

Further studies are needed to clarify the current findings and cardiologists need to become more comfortable with using insulin therapy, Dr. Wayne C. Levy and Dr. Irl B. Hirsch, from the University of Washington in Seattle, note in a related editorial. "If we can succeed with both of these goals, there is the potential to make major contributions for this growing patient population" with both diseases. J Am Coll Cardiol 2003;42:1044-1052.

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