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

Yu Kataoka, Satoshi Yasuda, Yoshihiro Miyamoto, Kazuhiro Sase, Masami Kosuge, Kazuo Kimura, Yasunao Yoshimasa, Shunichi Miyazaki

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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.

Original languageEnglish
Pages (from-to)697-705
Number of pages9
JournalJournal of Atherosclerosis and Thrombosis
Issue number7
Publication statusPublished - 2015 Jul 23


  • Disease progression
  • Early-stage diabetes
  • Obesity


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