DOES INSULIN THERAPY HAVE A HYPERTENSIVE EFFECT IN TYPE-2 DIABETES

In this prospective study, the 24-h blood-pressure profile of 12 patie nts with type 2 diabetes was monitored before, at 6, and at 12 weeks a fter initiation of insulin therapy, to determine whether commencement of insulin therapy increases blood pressure in these patients. Insulin dosage adjustment was carried out by using a predetermined algorithm according to body weight and degree of hyperglycemia. The mean insulin dosage at 12 weeks was 72.9 +/- 3.9 units/day. This was associated wi th an increase in systolic blood pressure from 134.6 +/- 4.3 mm Hg to 144.8 +/- 4.5 mm Hg (p = 0.0001), diastolic blood pressure from 71.9 /- 2.6 mm Hg to 74.9 +/- 2.2 mm Hg (p = 0.0001), and body mass index ( BMI) from 27.2 +/- 0.8 kg/m(2) to 29.6 +/- 0.8 kg/m(2) (p = 0.0001). M ultiple regression analysis showed insulin dosage to be a significant independent factor (p = 0.0003) accounting for 63% of the variance in blood pressure change after adjusting for age, diastolic blood pressur e, and base HbA(1c). We conclude that insulin therapy may have a delet erious effect on blood pressure in patent with type 2 diabetes. Howeve r, in the clinical setting, it is difficult to isolate this from the c onfounding effect of weight gain.