Changes in glycaemic control (but not in body weight control) are positively correlated with changes in coronary risk profile in diabetic patients.

Coronary Risk Profile (CRP), assessed according to the Framingham equation takes the presence of diabetes into account, but not the glycemic control o r the body overweight. We have performed an observational survey to study the respective roles of changes in body weight or glycaemic control on calculated CRP, in a given s ubject, by an effect on several items of the CRP equation (systolic blood p ressure, total and HDL cholesterol) which can be modified by blood glucose or weight. We have studied the CRP of 179 type 1 and 208 type 2 diabetes patients, adm itted in the department of diabetology of the Angers Hospital, twice (inter val<3 years: 1.6+/-0.8 yr). The patients yielded no coronary heart disease, their age ranged from 30 to 74 yr (mean+/-SD : 53+/-13), they were not on antihypertensive or lipid lowering medication. Glycemic control was assesse d by glyco-hamoglobin (HbA1c), systolic blood pressure (SBP) was measured w ith an automatic device (Dinamap). Total and HDL cholesterol were determine d by an enzymatic method, in fasting patients. Only age at first examinatio n was taken into account to compute CRP. Initially, SEP was 131+/-17 mmHg, total and HDL cholesterol were 2.20+/-0.4 7 et 0.56+/-0.20 g/L, respectively. SEP was positively correlated with body weight (Rho=0.310; p<0.0001), but not with HbA1c. Median 5 yr CRP was 5% ( range: <1% - 25%), Between both admissions, mean change in body weight, HbA 1c and 5 yr CRP was +1.0 kg (range: -27 a +29), -0.2% (range: -4.5 a +7.6) et -0.01% (range : -10 a +13) respectively. Change in CRP between both admi ssions was associated with change in HbA1c (Rho=0,109; p=0.0315) but not in body weight (Rho=0.072: p=0.1588), This result was explained by the effect of the change in HbA1c on total cholesterol (Rho=0.151: p=0.003), (no effe ct on SEP or HDL cholesterol: Rho=0.008 and Rho=0.019: NS, respectively). These results suggest that, in diabetic patients, changes in glycaemic cont rol affect their CRP by an effect on total cholesterol, but the changes in body weight do not affect their CRP.