Atheroma progression in obese early-stage diabetic Japanese patients in response to glycemic control: Sub-analysis from the DIANA study

Aim: diabetes is accompanied by abdominal obesity,which produces various metabolic abnormalities. while metabolic factors have been considered to promote the development of coronary atherosclerosis in the early-stage of diabetes,it remains unknown whether the presence of obesity in early-stage diabetics affects the natural history of coronary atherosclerosis. we herein investigated the characteristics of the disease substrate in obese early-stage diabetics. methods: the diana (diabetes) and diffuse coronary narrowing study was a serial evaluation of angiographic disease progression in early-stage diabetics with coronary artery disease. a total of 252 study subjects were stratified into non-obese (n = 168) and obese groups (n = 84). obesity in japanese subjects was defined as a body mass index > 25 kg/m2 according to the statement about japanese obesity from the japan society for the study of obesity. coronary atherosclerotic changes were evaluated by a quantitative computed analysis. the total lesion length (tll = total length of all atherosclerotic lesions) was compared between the groups. results: the obese patients were younger (p = 0.0002) and had higher levels of fasting (p = 0.002 and post prandial insulin (p = 0.01),and higher triglyceride levels (p = 0.02). on serial angiographic evaluations,obese patients had greater disease progression,reflected by a larger percent change in the tll (24.7 ± 13.7 vs. 7.4 ± 10.0%,(p = 0.04). however,the improvement of abnormal glucose tolerance was associated with a slowing of disease progression in both non-obese (-0.9± 10.7 vs. +15.0± 11.2%,p = 0.04 and obese (+4.2±22.8 vs. + 55.5 ± 26.5°%,p = 0.005) patients. conclusions: obese patients with early-stage diabetes exhibit profound disease progression. glycemic control attenuated the progression of their coronary atherosclerosis. our findings indicate progressive but modifiable disease in obese early-stage diabetics under optimal glycemic management. © 2015,japan atherosclerosis society. all rights reserved.