Issue 215 Item 11 Amino Acid Supplementation Prevents Myocardial Dysfunction in

Data can be important in designing an optimal dietetic approach for patients with type 2 diabetes to prevent progressive myocardial dysfunction. In patients with type 2 diabetes who have normal resting left ventricular (LV) function and do not have coronary artery disease (CAD), an increased supply of amino acids prevents myocardial dysfunction and improves metabolic control, according to a report in the June issue of the American Heart Journal.

"Diabetes mellitus is associated with an increased rate of cardiac amino acid catabolism that could interfere with cardiac function," Dr. Roldano Scognamiglio, of Policlinico Universitario, Padova, Italy, and colleagues write.

The team randomized 65 type 2 diabetic patents who had normal resting left ventricular ejection fraction (LVEF) and no obstructive CAD to receive 12 g/day of an oral amino acid mixture (AAM) or placebo for 12 weeks.

Treatment was then crossed over for another similar period. The investigators performed 2-dimensional echocardiography at rest and during isometric exercise at baseline and at the end of each treatment. Biochemical assays were also performed. Twenty adults matched for age, sex, and BMI served as controls.

Resting left ventricular dimensions and LVEF did not differ between patients and controls at baseline and during AAM or placebo treatment. In diabetic patients, there was a significant decrease in peak handgrip LVEF at baseline (63% versus 56%, p < 0.001) and during placebo treatment (62% versus 55%, p < 0.001) compared with the resting value.

Peak handgrip LVEF did not differ significantly from resting value during treatment with AAM (66% versus 64%, respectively). "Thus, exercise LVEF was higher during AAM treatment than both baseline and placebo treatment (66% versus 56% and versus 55%, p < 0.001)," Dr. Scognamiglio and colleagues write.

Glycated hemoglobin level was decreased after AAM treatment compared with placebo treatment (7.0% versus 7.6%, p < .05).

"Although the precise underlying pathophysiological mechanism(s) is (are) not completely known, these data may eventually be important in designing [an] optimal dietetic approach for patients with [diabetes mellitus type 2] to prevent progressive myocardial dysfunction," the authors conclude.
Am Heart J 2004;147:1106-1112.

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DID YOU KNOW: Continuous Subcutaneous Insulin Infusion More Effective Than Glargine Multiple Daily Injection. Lower HbA1c and premeal glucose levels were more achievable with CSII than with glargine-based MDI treatment. Continuous subcutaneous insulin infusion (CSII) improved glycemic control in children and adolescents with type 1 diabetes better than did multiple daily injection (MDI) with glargine, according to the results of a small, randomized, short-duration study published in the July issue of Diabetes Care.