PMID- 28683829
OWN - NLM
STAT- MEDLINE
DCOM- 20180412
LR  - 20181113
IS  - 1475-2840 (Electronic)
IS  - 1475-2840 (Linking)
VI  - 16
IP  - 1
DP  - 2017 Jul 6
TI  - alpha-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.
PG  - 86
LID - 10.1186/s12933-017-0571-1 [doi]
LID - 86
AB  - 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 ).
FAU - Shimabukuro, Michio
AU  - Shimabukuro M
AD  - Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical 
      University, Fukushima, Japan.
AD  - Department of Cardio-Diabetes Medicine, Institute of Biomedical Sciences, 
      Tokushima University Graduate School, Tokushima, Japan.
FAU - Tanaka, Atsushi
AU  - Tanaka A
AD  - Department of Cardiovascular Medicine, Saga University, Saga, Japan.
FAU - Sata, Masataka
AU  - Sata M
AD  - Department of Cardiovascular Medicine, Institute of Biomedical Sciences, 
      Tokushima University Graduate School, Tokushima, Japan.
FAU - Dai, Kazuoki
AU  - Dai K
AD  - Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan.
FAU - Shibata, Yoshisato
AU  - Shibata Y
AD  - Miyazaki Medical Association Hospital, Cardiovascular Center, Miyazaki, Japan.
FAU - Inoue, Yohei
AU  - Inoue Y
AD  - Department of Cardiovascular Medicine, Saga University, Saga, Japan.
AD  - Miyazaki Medical Association Hospital, Cardiovascular Center, Miyazaki, Japan.
FAU - Ikenaga, Hiroki
AU  - Ikenaga H
AD  - Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan.
FAU - Kishimoto, Shinji
AU  - Kishimoto S
AD  - Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan.
FAU - Ogasawara, Kozue
AU  - Ogasawara K
AD  - Department of Cardiovascular Medicine, Institute of Biomedical Sciences, 
      Tokushima University Graduate School, Tokushima, Japan.
FAU - Takashima, Akira
AU  - Takashima A
AD  - Department of Cardiovascular Medicine, Institute of Biomedical Sciences, 
      Tokushima University Graduate School, Tokushima, Japan.
FAU - Niki, Toshiyuki
AU  - Niki T
AD  - Department of Cardiovascular Medicine, Institute of Biomedical Sciences, 
      Tokushima University Graduate School, Tokushima, Japan.
FAU - Arasaki, Osamu
AU  - Arasaki O
AD  - Department of Cardiology, Tomishiro Central Hospital, Okinawa, Japan.
FAU - Oshiro, Koichi
AU  - Oshiro K
AD  - Department of Cardiology, Ohama Dai-ichi Hospital, Okinawa, Japan.
FAU - Mori, Yutaka
AU  - Mori Y
AD  - Division of Diabetes and Endocrinology, Department of Internal Medicine, Jikei 
      University School of Medicine, Tokyo, Japan.
FAU - Ishihara, Masaharu
AU  - Ishihara M
AD  - Division of Coronary Heart Disease, Department of Internal Medicine, Hyogo 
      College of Medicine, Nishinomiya, Japan.
FAU - Node, Koichi
AU  - Node K
AUID- ORCID: 0000-0002-2534-0939
AD  - Department of Cardiovascular Medicine, Saga University, Saga, Japan. 
      node@cc.saga-u.ac.jp.
CN  - Collaborators on the Effect of Miglitol on Glucose Metabolism in Acute Coronary 
      Syndrome (MACS) Study
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
DEP - 20170706
PL  - England
TA  - Cardiovasc Diabetol
JT  - Cardiovascular diabetology
JID - 101147637
RN  - 0 (Blood Glucose)
RN  - 0 (Glycoside Hydrolase Inhibitors)
RN  - 0 (Hypoglycemic Agents)
RN  - 0V5436JAQW (miglitol)
RN  - 19130-96-2 (1-Deoxynojirimycin)
RN  - IY9XDZ35W2 (Glucose)
SB  - IM
MH  - 1-Deoxynojirimycin/*analogs & derivatives/therapeutic use
MH  - Acute Coronary Syndrome/*drug therapy
MH  - Adult
MH  - Aged
MH  - Blood Glucose/drug effects
MH  - Diabetes Mellitus, Type 2/*drug therapy
MH  - Female
MH  - Glucose/biosynthesis
MH  - Glycoside Hydrolase Inhibitors/*therapeutic use
MH  - Heart Rate/drug effects
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Treatment Outcome
PMC - PMC5501494
OTO - NOTNLM
OT  - Acute coronary syndrome
OT  - Glucose fluctuation
OT  - Heart rate variability
OT  - Hypoglycemia
OT  - Miglitol
OT  - Sympathetic nervous system activity
OT  - Type 2 diabetes
EDAT- 2017/07/08 06:00
MHDA- 2018/04/13 06:00
PMCR- 2017/07/06
CRDT- 2017/07/08 06:00
PHST- 2017/04/07 00:00 [received]
PHST- 2017/06/26 00:00 [accepted]
PHST- 2017/07/08 06:00 [entrez]
PHST- 2017/07/08 06:00 [pubmed]
PHST- 2018/04/13 06:00 [medline]
PHST- 2017/07/06 00:00 [pmc-release]
AID - 10.1186/s12933-017-0571-1 [pii]
AID - 571 [pii]
AID - 10.1186/s12933-017-0571-1 [doi]
PST - epublish
SO  - Cardiovasc Diabetol. 2017 Jul 6;16(1):86. doi: 10.1186/s12933-017-0571-1.