Cited by 38Diabetes Treatment and ManagementDiabetes Management and ResearchHeart Rate Variability and Autonomic Control

α-Glucosidase inhibitor miglitol attenuates glucose fluctuation, heart rate variability and sympathetic activity in patients with type 2 diabetes and acute coronary syndrome: a multicenter randomized controlled (MACS) study

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Shimabukuro, Michio, Tanaka, Atsushi, Sata, Masataka, Dai, Kazuoki, Shibata, Yoshisato, Inoue, Yohei, Ikenaga, Hiroki, Kishimoto, Shinji +9 more·2017·Cardiovascular Diabetology

Abstract

Background: Little is known about clinical associations between glucose fluctuations including hypoglycemia, heart rate variability (HRV), and the activity of the sympathetic nervous system (SNS) in patients with acute phase of acute coronary syndrome (ACS). This pilot study aimed to evaluate the short-term effects of glucose fluctuations on HRV and SNS activity in type 2 diabetes mellitus (T2DM) patients with recent ACS. We also examined the effect of suppressing glucose fluctuations with miglitol on these variables. Methods: This prospective, randomized, open-label, blinded-endpoint, multicenter, parallel-group comparative study included 39 T2DM patients with recent ACS, who were randomly assigned to either a miglitol group (n = 19) or a control group (n = 20). After initial 24-h Holter electrocardiogram (ECG) (Day 1), miglitol was commenced and another 24-h Holter ECG (Day 2) was recorded. In addition, continuous glucose monitoring (CGM) was performed throughout the Holter ECG. Results: Although frequent episodes of subclinical hypoglycemia (≤4.44 mmo/L) during CGM were observed on Day 1 in the both groups (35% of patients in the control group and 31% in the miglitol group), glucose fluctuations were decreased and the minimum glucose level was increased with substantial reduction in the episodes of subclinical hypoglycemia to 7.7% in the miglitol group on Day 2. Holter ECG showed that the mean and maximum heart rate and mean LF/HF were increased on Day 2 in the control group, and these increases were attenuated by miglitol. When divided 24-h time periods into day-time (0700–1800 h), night-time (1800–0000 h), and bed-time (0000–0700 h), we found increased SNS activity during day-time, increased maximum heart rate during night-time, and glucose fluctuations during bed-time, which were attenuated by miglitol treatment. Conclusions: In T2DM patients with recent ACS, glucose fluctuations with subclinical hypoglycemia were associated with alterations of HRV and SNS activity, which were mitigated by miglitol, suggesting that these pathological relationships may be a residual therapeutic target in such patients. Trial registration Unique Trial Number, UMIN000005874 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000006929)

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Authors
Shimabukuro, M., Tanaka, A., Sata, M., Dai, K., Shibata, Y., Inoue, Y., Ikenaga, H., Kishimoto, S., Ogasawara, K., Takashima, A., Niki, T., Arasaki, O., Oshiro, K., Mori, Y., Ishihara, M., Node, K., & Study, O. B. O. T. C. O. T. E. O. M. O. G. M. I. A. C. S. (.
Affiliations
  • Fukushima Medical University (JP)
  • Saga University (JP)
  • Tokushima University (JP)
  • Miyazaki Medical Association Hospital (JP)
  • Tomishiro Central Hospital (JP)
  • Jikei University School of Medicine (JP)
  • Hyogo Medical University (JP)
Corresponding author
Node, Koichi
Venue
Cardiovascular Diabetology
Published
2017-07-06
Volume
16
Issue
1
Pages
86-86
ISSN
1475-2840 (ISSN-L)
OpenAlex
W2725327820
Cited by
38
References
35
Citations by year
2026: 2 · 2025: 5 · 2024: 8 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 3 · 2019: 5 · 2018: 8 · 2017: 1
FWCI
3.67
Type
journal article
Language
en
Open access
Locations
  • Cardiovascular Diabetology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by-nc-nd)
Funders
Japan Society for the Promotion of Science (16H05299, 16K01823)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
miglitol, alpha-glucosidase inhibitors, type 2 diabetes, acute coronary syndrome, glucose fluctuations, heart rate variability, sympathetic activity, continuous glucose monitoring, autonomic dysfunction, glycemic variability, cardiac autonomic function, LF/HF ratio, Holter electrocardiography
MeSH terms
Adult, Aged, Blood Glucose, Diabetes Mellitus, Type 2, Female, Glucose, Heart Rate, Humans, Hypoglycemic Agents, Male, Middle Aged, Treatment Outcome, 1-Deoxynojirimycin, Acute Coronary Syndrome, Glycoside Hydrolase Inhibitors

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