Skip to main content
Erschienen in: Acta Diabetologica 5/2015

01.10.2015 | Original Article

Long-term effects of baroreflex activation therapy on glucose metabolism

verfasst von: Manuel Wallbach, Luca-Yves Lehnig, Hans-Joachim Helms, Charlotte Schroer, Gerhard A. Müller, Rolf Wachter, Michael J. Koziolek

Erschienen in: Acta Diabetologica | Ausgabe 5/2015

Einloggen, um Zugang zu erhalten

Abstract

Aims

Sympathetic overactivity is one critical factor associated with the development of arterial hypertension, impaired insulin secretion and resistance. Some antihypertensives exert beneficial effects on glucose metabolism, whereas others lead to an impairment of metabolic state with consecutive weight gain. In resistant hypertension, baroreflex activation therapy (BAT) reduces arterial blood pressure (BP) by inhibition of the sympathetic nervous system. The objective of this study was to evaluate whether BAT influences metabolic state in patients with resistant hypertension.

Methods

Thirty patients with resistant hypertension (10 with known diabetes mellitus) were prospectively included into this study. Blood pressure, BMI, weight, fasting glucose, insulin, C-peptide, hemoglobin A1c, HOMA-IR, HOMA-β, ISQuickI, and glucose levels during oral glucose tolerance test were measured at baseline and 6 months after BAT activation.

Results

Fasting glucose was significantly reduced after 6 months of BAT, whereas mean 2-h glucose levels during oral glucose tolerance test, fasting insulin levels, C-peptide levels, hemoglobin A1c, HOMA-IR, HOMA-β, ISQuickI, weight, and BMI remained unchanged.

Conclusion

Despite improvement in fasting glucose, BAT exerts neither sustained additional beneficial effects nor an impairment of metabolic state. Thus, chronic BAT might be an effective interventional method to reduce BP without metabolic disadvantages.
Literatur
3.
Zurück zum Zitat Manrique C, Lastra G, Whaley-Connell A, Sowers JR (2005) Hypertension and the cardiometabolic syndrome. J Clin Hypertens (Greenwich) 7(8):471–476CrossRef Manrique C, Lastra G, Whaley-Connell A, Sowers JR (2005) Hypertension and the cardiometabolic syndrome. J Clin Hypertens (Greenwich) 7(8):471–476CrossRef
4.
Zurück zum Zitat Zavaroni I, Dall’Aglio E, Bonora E, Alpi O, Passeri M, Reaven GM (1987) Evidence that multiple risk factors for coronary artery disease exist in persons with abnormal glucose tolerance. Am J Med 83(4):609–612CrossRefPubMed Zavaroni I, Dall’Aglio E, Bonora E, Alpi O, Passeri M, Reaven GM (1987) Evidence that multiple risk factors for coronary artery disease exist in persons with abnormal glucose tolerance. Am J Med 83(4):609–612CrossRefPubMed
5.
Zurück zum Zitat Maheux P, Jeppesen J, Sheu WH, Hollenbeck CB, Clinkingbeard C, Greenfield MS, Chen YD, Reaven GM (1994) Additive effects of obesity, hypertension, and type 2 diabetes on insulin resistance. Hypertension 24(6):695–698CrossRefPubMed Maheux P, Jeppesen J, Sheu WH, Hollenbeck CB, Clinkingbeard C, Greenfield MS, Chen YD, Reaven GM (1994) Additive effects of obesity, hypertension, and type 2 diabetes on insulin resistance. Hypertension 24(6):695–698CrossRefPubMed
8.
Zurück zum Zitat Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Boudier HA, Zanchetti A, ESH-ESC Task Force on the Management of Arterial Hypertension (2007) 2007 ESH-ESC practice guidelines for the management of arterial hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens 25(9):1751–1762CrossRefPubMed Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Boudier HA, Zanchetti A, ESH-ESC Task Force on the Management of Arterial Hypertension (2007) 2007 ESH-ESC practice guidelines for the management of arterial hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens 25(9):1751–1762CrossRefPubMed
10.
Zurück zum Zitat Mahfoud F, Schlaich M, Kindermann I, Ukena C, Cremers B, Brandt MC, Hoppe UC, Vonend O, Rump LC, Sobotka PA, Krum H, Esler M, Bohm M (2011) Effect of renal sympathetic denervation on glucose metabolism in patients with resistant hypertension: a pilot study. Circulation 123(18):1940–1946. doi:10.1161/CIRCULATIONAHA.110.991869 CrossRefPubMed Mahfoud F, Schlaich M, Kindermann I, Ukena C, Cremers B, Brandt MC, Hoppe UC, Vonend O, Rump LC, Sobotka PA, Krum H, Esler M, Bohm M (2011) Effect of renal sympathetic denervation on glucose metabolism in patients with resistant hypertension: a pilot study. Circulation 123(18):1940–1946. doi:10.​1161/​CIRCULATIONAHA.​110.​991869 CrossRefPubMed
13.
Zurück zum Zitat Magen E, Feldman A, Cohen Z, Alon DB, Linov L, Mishal J, Schlezinger M (2010) Potential link between C3a, C3b and endothelial progenitor cells in resistant hypertension. Am J Med Sci 339(5):415–419PubMed Magen E, Feldman A, Cohen Z, Alon DB, Linov L, Mishal J, Schlezinger M (2010) Potential link between C3a, C3b and endothelial progenitor cells in resistant hypertension. Am J Med Sci 339(5):415–419PubMed
14.
Zurück zum Zitat Pollare T, Lithell H, Selinus I, Berne C (1989) Sensitivity to insulin during treatment with atenolol and metoprolol: a randomised, double blind study of effects on carbohydrate and lipoprotein metabolism in hypertensive patients. BMJ 298(6681):1152–1157PubMedCentralCrossRefPubMed Pollare T, Lithell H, Selinus I, Berne C (1989) Sensitivity to insulin during treatment with atenolol and metoprolol: a randomised, double blind study of effects on carbohydrate and lipoprotein metabolism in hypertensive patients. BMJ 298(6681):1152–1157PubMedCentralCrossRefPubMed
17.
Zurück zum Zitat Ernsberger P, Ishizuka T, Liu S, Farrell CJ, Bedol D, Koletsky RJ, Friedman JE (1999) Mechanisms of antihyperglycemic effects of moxonidine in the obese spontaneously hypertensive Koletsky rat (SHROB). J Pharmacol Exp Ther 288(1):139–147PubMed Ernsberger P, Ishizuka T, Liu S, Farrell CJ, Bedol D, Koletsky RJ, Friedman JE (1999) Mechanisms of antihyperglycemic effects of moxonidine in the obese spontaneously hypertensive Koletsky rat (SHROB). J Pharmacol Exp Ther 288(1):139–147PubMed
18.
Zurück zum Zitat Bisognano JD, Bakris G, Nadim MK, Sanchez L, Kroon AA, Schafer J, de Leeuw PW, Sica DA (2011) Baroreflex activation therapy lowers blood pressure in patients with resistant hypertension: results from the double-blind, randomized, placebo-controlled rheos pivotal trial. J Am Coll Cardiol 58(7):765–773CrossRefPubMed Bisognano JD, Bakris G, Nadim MK, Sanchez L, Kroon AA, Schafer J, de Leeuw PW, Sica DA (2011) Baroreflex activation therapy lowers blood pressure in patients with resistant hypertension: results from the double-blind, randomized, placebo-controlled rheos pivotal trial. J Am Coll Cardiol 58(7):765–773CrossRefPubMed
20.
Zurück zum Zitat May M, Ahrens J, Menne J, Haller H, Beige J, Eckert S, Jordan J, Engeli S (2014) Limited acute influences of electrical baroreceptor activation on insulin sensitivity and glucose delivery: a randomized, double-blind, cross-over clinical study. Diabetes. doi:10.2337/db13-1651 May M, Ahrens J, Menne J, Haller H, Beige J, Eckert S, Jordan J, Engeli S (2014) Limited acute influences of electrical baroreceptor activation on insulin sensitivity and glucose delivery: a randomized, double-blind, cross-over clinical study. Diabetes. doi:10.​2337/​db13-1651
21.
Zurück zum Zitat Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood, Pressure. (2003) National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42:1206–1252CrossRefPubMed Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood, Pressure. (2003) National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42:1206–1252CrossRefPubMed
22.
Zurück zum Zitat Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Burnier M, Ambrosioni E, Caufield M, Coca A, Olsen MH, Tsioufis C, van de Borne P, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Ferrari R, Hasdai D, Hoes AW, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Clement DL, Gillebert TC, Rosei EA, Anker SD, Bauersachs J, Hitij JB, Caulfield M, De Buyzere M, De Geest S, Derumeaux GA, Erdine S, Farsang C, Funck-Brentano C, Gerc V, Germano G, Gielen S, Haller H, Jordan J, Kahan T, Komajda M, Lovic D, Mahrholdt H, Ostergren J, Parati G, Perk J, Polonia J, Popescu BA, Reiner Z, Ryden L, Sirenko Y, Stanton A, Struijker-Boudier H, Vlachopoulos C, Volpe M, Wood DA (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 34(28):2159–2219. doi:10.1093/eurheartj/eht151 CrossRefPubMed Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F, Burnier M, Ambrosioni E, Caufield M, Coca A, Olsen MH, Tsioufis C, van de Borne P, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Ferrari R, Hasdai D, Hoes AW, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Clement DL, Gillebert TC, Rosei EA, Anker SD, Bauersachs J, Hitij JB, Caulfield M, De Buyzere M, De Geest S, Derumeaux GA, Erdine S, Farsang C, Funck-Brentano C, Gerc V, Germano G, Gielen S, Haller H, Jordan J, Kahan T, Komajda M, Lovic D, Mahrholdt H, Ostergren J, Parati G, Perk J, Polonia J, Popescu BA, Reiner Z, Ryden L, Sirenko Y, Stanton A, Struijker-Boudier H, Vlachopoulos C, Volpe M, Wood DA (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 34(28):2159–2219. doi:10.​1093/​eurheartj/​eht151 CrossRefPubMed
23.
Zurück zum Zitat Tordoir JH, Scheffers I, Schmidli J, Savolainen H, Liebeskind U, Hansky B, Herold U, Irwin E, Kroon AA, de Leeuw P, Peters TK, Kieval R, Cody R (2007) An implantable carotid sinus baroreflex activating system: surgical technique and short-term outcome from a multi-center feasibility trial for the treatment of resistant hypertension. Eur J Vasc Endovasc Surg 33(4):414–421. doi:10.1016/j.ejvs.2006.11.025 CrossRefPubMed Tordoir JH, Scheffers I, Schmidli J, Savolainen H, Liebeskind U, Hansky B, Herold U, Irwin E, Kroon AA, de Leeuw P, Peters TK, Kieval R, Cody R (2007) An implantable carotid sinus baroreflex activating system: surgical technique and short-term outcome from a multi-center feasibility trial for the treatment of resistant hypertension. Eur J Vasc Endovasc Surg 33(4):414–421. doi:10.​1016/​j.​ejvs.​2006.​11.​025 CrossRefPubMed
24.
Zurück zum Zitat Hoppe UC, Brandt MC, Wachter R, Beige J, Rump LC, Kroon AA, Cates AW, Lovett EG, Haller H (2012) Minimally invasive system for baroreflex activation therapy chronically lowers blood pressure with pacemaker-like safety profile: results from the Barostim neo trial. J Am Soc Hypertens 6(4):270–276CrossRefPubMed Hoppe UC, Brandt MC, Wachter R, Beige J, Rump LC, Kroon AA, Cates AW, Lovett EG, Haller H (2012) Minimally invasive system for baroreflex activation therapy chronically lowers blood pressure with pacemaker-like safety profile: results from the Barostim neo trial. J Am Soc Hypertens 6(4):270–276CrossRefPubMed
26.
Zurück zum Zitat Stahrenberg R, Edelmann F, Mende M, Kockskamper A, Dungen HD, Scherer M, Kochen MM, Binder L, Herrmann-Lingen C, Schonbrunn L, Gelbrich G, Hasenfuss G, Pieske B, Wachter R (2010) Association of glucose metabolism with diastolic function along the diabetic continuum. Diabetologia 53(7):1331–1340. doi:10.1007/s00125-010-1718-8 PubMedCentralCrossRefPubMed Stahrenberg R, Edelmann F, Mende M, Kockskamper A, Dungen HD, Scherer M, Kochen MM, Binder L, Herrmann-Lingen C, Schonbrunn L, Gelbrich G, Hasenfuss G, Pieske B, Wachter R (2010) Association of glucose metabolism with diastolic function along the diabetic continuum. Diabetologia 53(7):1331–1340. doi:10.​1007/​s00125-010-1718-8 PubMedCentralCrossRefPubMed
28.
Zurück zum Zitat Ebinc H, Ozkurt ZN, Ebinc FA, Ucardag D, Caglayan O, Yilmaz M (2008) Effects of sympatholytic therapy with moxonidine on serum adiponectin levels in hypertensive women. J Int Med Res 36(1):80–87CrossRefPubMed Ebinc H, Ozkurt ZN, Ebinc FA, Ucardag D, Caglayan O, Yilmaz M (2008) Effects of sympatholytic therapy with moxonidine on serum adiponectin levels in hypertensive women. J Int Med Res 36(1):80–87CrossRefPubMed
30.
Zurück zum Zitat Yakubu-Madus FE, Johnson WT, Zimmerman KM, Dananberg J, Steinberg MI (1999) Metabolic and hemodynamic effects of moxonidine in the Zucker diabetic fatty rat model of type 2 diabetes. Diabetes 48(5):1093–1100CrossRefPubMed Yakubu-Madus FE, Johnson WT, Zimmerman KM, Dananberg J, Steinberg MI (1999) Metabolic and hemodynamic effects of moxonidine in the Zucker diabetic fatty rat model of type 2 diabetes. Diabetes 48(5):1093–1100CrossRefPubMed
31.
Zurück zum Zitat Bhatt DL, Kandzari DE, O’Neill WW, D’Agostino R, Flack JM, Katzen BT, Leon MB, Liu M, Mauri L, Negoita M, Cohen SA, Oparil S, Rocha-Singh K, Townsend RR, Bakris GL (2014) A controlled trial of renal denervation for resistant hypertension. N Engl J Med 370(15):1393–1401. doi:10.1056/NEJMoa1402670 CrossRefPubMed Bhatt DL, Kandzari DE, O’Neill WW, D’Agostino R, Flack JM, Katzen BT, Leon MB, Liu M, Mauri L, Negoita M, Cohen SA, Oparil S, Rocha-Singh K, Townsend RR, Bakris GL (2014) A controlled trial of renal denervation for resistant hypertension. N Engl J Med 370(15):1393–1401. doi:10.​1056/​NEJMoa1402670 CrossRefPubMed
32.
Zurück zum Zitat Gerritsen J, Dekker JM, TenVoorde BJ, Kostense PJ, Heine RJ, Bouter LM, Heethaar RM, Stehouwer CD (2001) Impaired autonomic function is associated with increased mortality, especially in subjects with diabetes, hypertension, or a history of cardiovascular disease: the Hoorn Study. Diabetes Care 24(10):1793–1798CrossRefPubMed Gerritsen J, Dekker JM, TenVoorde BJ, Kostense PJ, Heine RJ, Bouter LM, Heethaar RM, Stehouwer CD (2001) Impaired autonomic function is associated with increased mortality, especially in subjects with diabetes, hypertension, or a history of cardiovascular disease: the Hoorn Study. Diabetes Care 24(10):1793–1798CrossRefPubMed
33.
Zurück zum Zitat Wu JS, Lu FH, Yang YC, Chang SH, Huang YH, Chen JJ, Chang CJ (2014) Impaired baroreflex sensitivity in subjects with impaired glucose tolerance, but not isolated impaired fasting glucose. Acta Diabetol 51(4):535–541. doi:10.1007/s00592-013-0548-9 CrossRefPubMed Wu JS, Lu FH, Yang YC, Chang SH, Huang YH, Chen JJ, Chang CJ (2014) Impaired baroreflex sensitivity in subjects with impaired glucose tolerance, but not isolated impaired fasting glucose. Acta Diabetol 51(4):535–541. doi:10.​1007/​s00592-013-0548-9 CrossRefPubMed
34.
Zurück zum Zitat Straznicky NE, Grima MT, Sari CI, Eikelis N, Lambert EA, Nestel PJ, Esler MD, Dixon JB, Chopra R, Tilbrook AJ, Schlaich MP, Lambert GW (2012) Neuroadrenergic dysfunction along the diabetes continuum: a comparative study in obese metabolic syndrome subjects. Diabetes 61(10):2506–2516. doi:10.2337/db12-0138 PubMedCentralCrossRefPubMed Straznicky NE, Grima MT, Sari CI, Eikelis N, Lambert EA, Nestel PJ, Esler MD, Dixon JB, Chopra R, Tilbrook AJ, Schlaich MP, Lambert GW (2012) Neuroadrenergic dysfunction along the diabetes continuum: a comparative study in obese metabolic syndrome subjects. Diabetes 61(10):2506–2516. doi:10.​2337/​db12-0138 PubMedCentralCrossRefPubMed
35.
Zurück zum Zitat Kiviniemi AM, Hautala AJ, Karjalainen JJ, Piira OP, Lepojarvi S, Tiinanen S, Seppanen T, Ukkola O, Huikuri HV, Tulppo MP (2013) Impact of type 2 diabetes on cardiac autonomic responses to sympathetic stimuli in patients with coronary artery disease. Auton Neurosci 179(1–2):142–147. doi:10.1016/j.autneu.2013.08.068 CrossRefPubMed Kiviniemi AM, Hautala AJ, Karjalainen JJ, Piira OP, Lepojarvi S, Tiinanen S, Seppanen T, Ukkola O, Huikuri HV, Tulppo MP (2013) Impact of type 2 diabetes on cardiac autonomic responses to sympathetic stimuli in patients with coronary artery disease. Auton Neurosci 179(1–2):142–147. doi:10.​1016/​j.​autneu.​2013.​08.​068 CrossRefPubMed
37.
Zurück zum Zitat Lucini D, Zuccotti GV, Scaramuzza A, Malacarne M, Gervasi F, Pagani M (2013) Exercise might improve cardiovascular autonomic regulation in adolescents with type 1 diabetes. Acta Diabetol 50(3):341–349. doi:10.1007/s00592-012-0416-z CrossRefPubMed Lucini D, Zuccotti GV, Scaramuzza A, Malacarne M, Gervasi F, Pagani M (2013) Exercise might improve cardiovascular autonomic regulation in adolescents with type 1 diabetes. Acta Diabetol 50(3):341–349. doi:10.​1007/​s00592-012-0416-z CrossRefPubMed
39.
Zurück zum Zitat Kvist-Reimer M, Sundler F, Ahren B (2002) Effects of chemical sympathectomy by means of 6-hydroxydopamine on insulin secretion and islet morphology in alloxan-diabetic mice. Cell Tissue Res 307(2):203–209. doi:10.1007/s00441-001-0496-5 CrossRefPubMed Kvist-Reimer M, Sundler F, Ahren B (2002) Effects of chemical sympathectomy by means of 6-hydroxydopamine on insulin secretion and islet morphology in alloxan-diabetic mice. Cell Tissue Res 307(2):203–209. doi:10.​1007/​s00441-001-0496-5 CrossRefPubMed
40.
Zurück zum Zitat Ostenson CG, Hjemdahl P, Efendic S (1993) Release of catecholamines is increased but does not contribute to the impaired insulin secretion in the perfused pancreata of diabetic rats. Pancreas 8(1):34–38CrossRefPubMed Ostenson CG, Hjemdahl P, Efendic S (1993) Release of catecholamines is increased but does not contribute to the impaired insulin secretion in the perfused pancreata of diabetic rats. Pancreas 8(1):34–38CrossRefPubMed
41.
Zurück zum Zitat Barr EL, Zimmet PZ, Welborn TA, Jolley D, Magliano DJ, Dunstan DW, Cameron AJ, Dwyer T, Taylor HR, Tonkin AM, Wong TY, McNeil J, Shaw JE (2007) Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation 116(2):151–157. doi:10.1161/CIRCULATIONAHA.106.685628 CrossRefPubMed Barr EL, Zimmet PZ, Welborn TA, Jolley D, Magliano DJ, Dunstan DW, Cameron AJ, Dwyer T, Taylor HR, Tonkin AM, Wong TY, McNeil J, Shaw JE (2007) Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation 116(2):151–157. doi:10.​1161/​CIRCULATIONAHA.​106.​685628 CrossRefPubMed
42.
Zurück zum Zitat Coutinho M, Gerstein HC, Wang Y, Yusuf S (1999) The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care 22(2):233–240CrossRefPubMed Coutinho M, Gerstein HC, Wang Y, Yusuf S (1999) The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care 22(2):233–240CrossRefPubMed
Metadaten
Titel
Long-term effects of baroreflex activation therapy on glucose metabolism
verfasst von
Manuel Wallbach
Luca-Yves Lehnig
Hans-Joachim Helms
Charlotte Schroer
Gerhard A. Müller
Rolf Wachter
Michael J. Koziolek
Publikationsdatum
01.10.2015
Verlag
Springer Milan
Erschienen in
Acta Diabetologica / Ausgabe 5/2015
Print ISSN: 0940-5429
Elektronische ISSN: 1432-5233
DOI
https://doi.org/10.1007/s00592-014-0679-7

Weitere Artikel der Ausgabe 5/2015

Acta Diabetologica 5/2015 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.