A copper(II)-selective chelator ameliorates left-ventricular hypertrophy in type 2 diabetic patients: a randomised placebo-controlled study

AIMS/HYPOTHESIS

Cu(II)-selective chelation with trientine ameliorates cardiovascular and renal disease in a model of diabetes in rats. Here, we tested the hypothesis that Cu(II)-selective chelation might improve left ventricular hypertrophy (LVH) in type 2 diabetic patients.

METHODS

We performed a 12 month randomised placebo-controlled study of the effects of treatment with the Cu(II)-selective chelator trientine (triethylenetetramine dihydrochloride, 600 mg given orally twice daily) on LVH in diabetic patients (n = 15/group at baseline) in an outpatient setting wherein participants, caregivers and those assessing outcomes were blinded to group assignment. Using MRI, we measured left ventricular variables at baseline, and at months 6 and 12. The change from baseline in left ventricular mass indexed to body surface area (LVM(bsa)) was the primary endpoint variable.

RESULTS

Diabetic patients had LVH with preserved ejection fraction at baseline. Trientine treatment decreased LVM(bsa) by 5.0 +/- 7.2 g/m(2) (mean +/- SD) at month 6 (when 14 trientine-treated and 14 placebo-treated participants were analysed; p = 0.0056 compared with placebo) and by 10.6 +/- 7.6 g/m(2) at month 12 (when nine trientine-treated and 13 placebo-treated participants were analysed; p = 0.0088), whereas LVM(bsa) was unchanged by placebo treatment. In a multiple-regression model that explained ~75% of variation (R (2) = 0.748, p = 0.001), cumulative urinary Cu excretion over 12 months was positively associated with trientine-evoked decreases in LVM(bsa).

CONCLUSIONS/INTERPRETATION

Cu(II)-selective chelation merits further exploration as a potential pharmacotherapy for diabetic heart disease.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN 12609000053224 FUNDING: The Endocore Research Trust; Lottery Health New Zealand; the Maurice and Phyllis Paykel Trust; the Foundation of Research, Science and Technology (New Zealand); the Health Research Council of New Zealand; the Ministry of Education (New Zealand) through the Maurice Wilkins Centre for Molecular Biodiscovery; and the Protemix Corporation.

Notification of random hyperglycaemia to general practitioners by an emergency medicine team: impact of a simple intervention plan

AIM

To determine whether general practitioners (GPs) were being appropriately notified of patients' elevated random glucose levels by emergency medicine (EM) staff, and to investigate whether two simple interventions improved the notification rate.

METHODS

Patients were included if their random venous plasma glucose (RVPG) at presentation to the Emergency Department (ED) was >or= 7.8 mmol/l and if they were discharged directly to their GP. Patients with known impaired glucose metabolism (IGM) were excluded. Patient discharge summaries were reviewed over a 5-month period before and a 5-week period after two simple interventions: first, a targeted educational session for EM staff and second, modifications to the automated message accompanying laboratory results.

RESULTS

Before intervention, the GPs of 120 out of 178 patients received no notification of an elevated RVPG compared with 23 of 62 patients after intervention (P < 0.00001). Notification met a predefined standard in 25 of 178 patients before, and 34 of 62 patients after intervention (P < 0.01).

CONCLUSIONS

EM staff education, together with an automated laboratory message, significantly improved the rate and quality of notification of elevated RVPG levels to GPs. These simple measures have the potential to hasten implementation of preventive and therapeutic measures in patients with IGM.

Thyrotoxic, hypokalaemic periodic paralysis: Polynesians, an ethnic group at risk

BACKGROUND

Thyrotoxic, hypokalaemic periodic paralysis (TPP) is a reversible cause of severe muscle weakness that occurs in a small minority of thyrotoxic patients. Most cases to date have been reported in Asian men.

AIMS

To evaluate the ethnic distribution of patients with TPP.

METHODS

Retrospective analysis of all patients presenting with thyrotoxicosis and hypokalaemia with paralysis to two New Zealand hospitals.

RESULTS

Seventy-one per cent of the 21 patients with TPP were of Polynesian ethnicity (Maori and Pacific Islander), 24% Asian and 5% European. Based on population demographics, these figures suggest a 37-fold overrepresentation for Polynesians and 159-fold for Asians compared with New Zealand Europeans.

CONCLUSION

Polynesian, in addition to Asian people, are two ethnic groups at particular risk of TPP, and this condition must be considered in the differential diagnosis for patients presenting to the emergency department with severe hypokalaemia and weakness.