<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03248271</url>
  </required_header>
  <id_info>
    <org_study_id>H17-01663</org_study_id>
    <nct_id>NCT03248271</nct_id>
  </id_info>
  <brief_title>Effects of Insulin on Hypotension and Sarcopenia</brief_title>
  <official_title>Effects of Insulin on Hypotension and Sarcopenia</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Kenneth Madden</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>University of British Columbia</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      In this study investigator's aim to determine the impact of insulin therapy on hypotension&#xD;
      and sarcopenia&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Diabetes is common in the elderly. By the age of 70, approximately 25% of the population has&#xD;
      diabetes and another 25% is at risk for diabetes. Elderly patients with diabetes are at&#xD;
      increased risk for disability and reduction in their instrumental and basic activities of&#xD;
      daily living. The prevalence of frailty is higher in people with diabetes that with age&#xD;
      matched controls without diabetes. One of the major contributing factors to frailty is&#xD;
      sarcopenia.&#xD;
&#xD;
      Insulin is an important anabolic hormone that prevents protein breakdown and to a lesser&#xD;
      extent stimulates protein synthesis. There is some evidence that the ability of insulin to&#xD;
      stimulate anabolic processes may be reduced in diabetes.&#xD;
&#xD;
      Insulin has cardiovascular properties, resulting in simultaneous adrenergic and vasodilatory&#xD;
      responses that have opposing influences on blood pressure. Epidemiological studies have&#xD;
      demonstrated that the use of insulin is a risk factor for syncope.&#xD;
&#xD;
      The investigators will study 30 older adults age 65 and older with type 2 diabetes who have&#xD;
      never taken insulin to manage their diabetes but now need insulin to manage their diabetes.&#xD;
      Data will be compared pre insulin start and 3 and 6 months after starting insulin.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Withdrawn</overall_status>
  <why_stopped>
    Study design was changed to the study was changed to Insulin, hypotension and sarcopenia.&#xD;
  </why_stopped>
  <start_date type="Actual">October 1, 2017</start_date>
  <completion_date type="Actual">January 10, 2023</completion_date>
  <primary_completion_date type="Actual">January 10, 2023</primary_completion_date>
  <study_type>Observational</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Cohort</observational_model>
    <time_perspective>Prospective</time_perspective>
  </study_design_info>
  <primary_outcome>
    <measure>Body composition</measure>
    <time_frame>Change from months 0, 3 and 6 months post insulin start</time_frame>
    <description>Measured by DEXA Scan</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Grip strength</measure>
    <time_frame>Change from months 0, 3 and 6 months post insulin start</time_frame>
    <description>measured by Hand Dynamometer</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Physical functioning Survey</measure>
    <time_frame>Change from months 0, 3 and 6 months post insulin start</time_frame>
    <description>measured by the Physical Component Summary from the SF-12 Health</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Presence or absence of orthostatic hypotension</measure>
    <time_frame>Change from months 0, 3 and 6 months post insulin start</time_frame>
    <description>Drop in systolic blood pressure of greater than 20 mmHg after 3 minutes of standing</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Nadir of systolic blood pressure during the Tilt Table Test</measure>
    <time_frame>Change from months 0, 3 and 6 months post insulin start</time_frame>
    <description>Lowest systolic blood pressure obtained during the Tilt Table Test</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Nadir of diastolic blood pressure during the Tilt Table Test</measure>
    <time_frame>Change from months 0, 3 and 6 months post insulin start</time_frame>
    <description>Lowest diastolic blood pressure obtained during the Tilt Table Test</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Nadir of middle cerebral artery velocity as measured by transcranial doppler</measure>
    <time_frame>Change from months 0, 3 and 6 months post insulin start</time_frame>
    <description>Lowest middle cerebral artery velocity obtained during the Tilt Table Test</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Presence or absence of a positive Tilt Table Test (vasovagal syncope)</measure>
    <time_frame>Change from months 0, 3 and 6 months post insulin start</time_frame>
    <description>Sudden drop in blood pressure and heart rate that leads to fainting</description>
  </secondary_outcome>
  <number_of_groups>1</number_of_groups>
  <enrollment type="Actual">0</enrollment>
  <condition>Diabetes</condition>
  <condition>Sarcopenia</condition>
  <condition>Hypotension, Orthostatic</condition>
  <arm_group>
    <arm_group_label>Type 2 Diabetes, Insulin Naive</arm_group_label>
    <description>Study participants will be tested prior to and 3 and 6 months after starting insulin to manage their diabetes</description>
  </arm_group>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>Insulin Lispro</intervention_name>
    <description>Insulin</description>
    <arm_group_label>Type 2 Diabetes, Insulin Naive</arm_group_label>
    <other_name>Humalog</other_name>
  </intervention>
  <eligibility>
    <study_pop>
      <textblock>
        Older adults age 65 and older with type 2 diabetes who do not use insulin to manage their&#xD;
        diabetes.&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Non-Probability Sample</sampling_method>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  65 years of age or older&#xD;
&#xD;
          -  Type 2 diabetes for at least 5 years&#xD;
&#xD;
          -  Insulin naive&#xD;
&#xD;
          -  now needs insulin to manage diabetes&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  anemia as defined by serum hematocrit&#xD;
&#xD;
          -  abnormal liver function tests&#xD;
&#xD;
          -  elevated serum creatinine&#xD;
&#xD;
          -  smoked within last 5 years&#xD;
&#xD;
          -  musculoskeletal or neurological condition that would preclude tilt table testing or&#xD;
             orthostatic vitals&#xD;
&#xD;
          -  aortic stenosis&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>65 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
  </eligibility>
  <overall_official>
    <last_name>Madden M Kenneth, MD</last_name>
    <role>Principal Investigator</role>
    <affiliation>University of British Columbia/Gerontology Research Lab</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>University of British Columbia - Gerontology Research Lab</name>
      <address>
        <city>Vancouver</city>
        <state>British Columbia</state>
        <zip>V5Z 1M9</zip>
        <country>Canada</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Canada</country>
  </location_countries>
  <reference>
    <citation>Morley JE, Malmstrom TK, Rodriguez-Manas L, Sinclair AJ. Frailty, sarcopenia and diabetes. J Am Med Dir Assoc. 2014 Dec;15(12):853-9. doi: 10.1016/j.jamda.2014.10.001. Epub 2014 Nov 20. No abstract available.</citation>
    <PMID>25455530</PMID>
  </reference>
  <reference>
    <citation>Rizzo MR, Barbieri M, Fava I, Desiderio M, Coppola C, Marfella R, Paolisso G. Sarcopenia in Elderly Diabetic Patients: Role of Dipeptidyl Peptidase 4 Inhibitors. J Am Med Dir Assoc. 2016 Oct 1;17(10):896-901. doi: 10.1016/j.jamda.2016.04.016. Epub 2016 Jun 2.</citation>
    <PMID>27262494</PMID>
  </reference>
  <reference>
    <citation>Canadian Diabetes Association Clinical Practice Guidelines Expert Committee; Meneilly GS, Knip A, Tessier D. Diabetes in the elderly. Can J Diabetes. 2013 Apr;37 Suppl 1:S184-90. doi: 10.1016/j.jcjd.2013.01.045. Epub 2013 Mar 26. No abstract available.</citation>
    <PMID>24070944</PMID>
  </reference>
  <reference>
    <citation>Leenders M, Verdijk LB, van der Hoeven L, Adam JJ, van Kranenburg J, Nilwik R, van Loon LJ. Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc. 2013 Aug;14(8):585-92. doi: 10.1016/j.jamda.2013.02.006. Epub 2013 Mar 26.</citation>
    <PMID>23537893</PMID>
  </reference>
  <reference>
    <citation>Bassil MS, Gougeon R. Muscle protein anabolism in type 2 diabetes. Curr Opin Clin Nutr Metab Care. 2013 Jan;16(1):83-8. doi: 10.1097/MCO.0b013e32835a88ee.</citation>
    <PMID>23196814</PMID>
  </reference>
  <reference>
    <citation>Salle A, Guilloteau G, Ryan M, Bouhanick B, Ritz P. Effect of insulin treatment on the body composition of Type 2 diabetic patients. Diabet Med. 2004 Dec;21(12):1298-303. doi: 10.1111/j.1464-5491.2004.01335.x.</citation>
    <PMID>15569132</PMID>
  </reference>
  <reference>
    <citation>Gin H, Rigalleau V, Perlemoine C. Insulin therapy and body weight, body composition and muscular strength in patients with type 2 diabetes mellitus. J Nutr Metab. 2010;2010:340570. doi: 10.1155/2010/340570. Epub 2009 Oct 21.</citation>
    <PMID>20721344</PMID>
  </reference>
  <reference>
    <citation>de Kanter M, Lilja B, Elmstahl S, Eriksson KF, Sundkvist G. A prospective study of orthostatic blood pressure in diabetic patients. Clin Auton Res. 1998 Aug;8(4):189-93. doi: 10.1007/BF02267780.</citation>
    <PMID>9791738</PMID>
  </reference>
  <reference>
    <citation>Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med. 2007 Oct;120(10):841-7. doi: 10.1016/j.amjmed.2007.02.023.</citation>
    <PMID>17904451</PMID>
  </reference>
  <reference>
    <citation>Vinik AI, Erbas T. Cardiovascular autonomic neuropathy: diagnosis and management. Curr Diab Rep. 2006 Dec;6(6):424-30. doi: 10.1007/s11892-006-0074-z.</citation>
    <PMID>17118224</PMID>
  </reference>
  <reference>
    <citation>Tack CJ, Lenders JW, Willemsen JJ, van Druten JA, Thien T, Lutterman JA, Smits P. Insulin stimulates epinephrine release under euglycemic conditions in humans. Metabolism. 1998 Mar;47(3):243-9. doi: 10.1016/s0026-0495(98)90251-7.</citation>
    <PMID>9500557</PMID>
  </reference>
  <reference>
    <citation>Tack CJ, Smits P, Willemsen JJ, Lenders JW, Thien T, Lutterman JA. Effects of insulin on vascular tone and sympathetic nervous system in NIDDM. Diabetes. 1996 Jan;45(1):15-22. doi: 10.2337/diab.45.1.15.</citation>
    <PMID>8522054</PMID>
  </reference>
  <reference>
    <citation>Meneilly GS, Elliott T, Battistini B, Floras JS. N(G)-monomethyl-L-arginine alters insulin-mediated calf blood flow but not glucose disposal in the elderly. Metabolism. 2001 Mar;50(3):306-10. doi: 10.1053/meta.2001.19493.</citation>
    <PMID>11230783</PMID>
  </reference>
  <reference>
    <citation>Lipsitz LA, Pluchino FC, Wei JY, Rowe JW. Syncope in institutionalized elderly: the impact of multiple pathological conditions and situational stress. J Chronic Dis. 1986;39(8):619-30. doi: 10.1016/0021-9681(86)90187-6.</citation>
    <PMID>3090090</PMID>
  </reference>
  <reference>
    <citation>Ruiz GA, Calvar C, Hermes R, Rivadeneira D, Bengolea V, Chirife R, Tentori MC, Gelpi RJ. Insulin sensitivity in young women with vasovagal syncope. Am Heart J. 2003 May;145(5):834-40. doi: 10.1016/S0002-8703(02)94707-1.</citation>
    <PMID>12766740</PMID>
  </reference>
  <reference>
    <citation>Stratton JR, Cerqueira MD, Schwartz RS, Levy WC, Veith RC, Kahn SE, Abrass IB. Differences in cardiovascular responses to isoproterenol in relation to age and exercise training in healthy men. Circulation. 1992 Aug;86(2):504-12. doi: 10.1161/01.cir.86.2.504.</citation>
    <PMID>1638718</PMID>
  </reference>
  <reference>
    <citation>Madden KM, Tedder G, Lockhart C, Meneilly GS. Euglycemic hyperinsulinemia alters the response to orthostatic stress in older adults with type 2 diabetes. Diabetes Care. 2008 Nov;31(11):2203-8. doi: 10.2337/dc08-1058. Epub 2008 Aug 20.</citation>
    <PMID>18716048</PMID>
  </reference>
  <reference>
    <citation>Sergi G, De Rui M, Stubbs B, Veronese N, Manzato E. Measurement of lean body mass using bioelectrical impedance analysis: a consideration of the pros and cons. Aging Clin Exp Res. 2017 Aug;29(4):591-597. doi: 10.1007/s40520-016-0622-6. Epub 2016 Aug 27.</citation>
    <PMID>27568020</PMID>
  </reference>
  <reference>
    <citation>Ziegler D, Laux G, Dannehl K, Spuler M, Muhlen H, Mayer P, Gries FA. Assessment of cardiovascular autonomic function: age-related normal ranges and reproducibility of spectral analysis, vector analysis, and standard tests of heart rate variation and blood pressure responses. Diabet Med. 1992 Mar;9(2):166-75. doi: 10.1111/j.1464-5491.1992.tb01754.x.</citation>
    <PMID>1563252</PMID>
  </reference>
  <reference>
    <citation>Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005 Aug 30;173(5):489-95. doi: 10.1503/cmaj.050051.</citation>
    <PMID>16129869</PMID>
  </reference>
  <reference>
    <citation>Del Rosso A, Ungar A, Bartoli P, Cellai T, Mussi C, Marchionni N, Masotti G; Gruppo Italiano di Studio Della Sincope Dell'anziano. Usefulness and safety of shortened head-up tilt testing potentiated with sublingual glyceryl trinitrate in older patients with recurrent unexplained syncope. J Am Geriatr Soc. 2002 Aug;50(8):1324-8. doi: 10.1046/j.1532-5415.2002.50351.x.</citation>
    <PMID>12164986</PMID>
  </reference>
  <reference>
    <citation>Lipsitz LA, Mukai S, Hamner J, Gagnon M, Babikian V. Dynamic regulation of middle cerebral artery blood flow velocity in aging and hypertension. Stroke. 2000 Aug;31(8):1897-903. doi: 10.1161/01.str.31.8.1897.</citation>
    <PMID>10926954</PMID>
  </reference>
  <verification_date>January 2023</verification_date>
  <study_first_submitted>August 7, 2017</study_first_submitted>
  <study_first_submitted_qc>August 9, 2017</study_first_submitted_qc>
  <study_first_posted type="Actual">August 14, 2017</study_first_posted>
  <last_update_submitted>January 10, 2023</last_update_submitted>
  <last_update_submitted_qc>January 10, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">January 12, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor-Investigator</responsible_party_type>
    <investigator_affiliation>University of British Columbia</investigator_affiliation>
    <investigator_full_name>Kenneth Madden</investigator_full_name>
    <investigator_title>Associate Professor, UBC Department of Medicine</investigator_title>
  </responsible_party>
  <keyword>Diabetes</keyword>
  <keyword>Sarcopenia</keyword>
  <keyword>Hypotension</keyword>
  <keyword>Tilt Table Test</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Sarcopenia</mesh_term>
    <mesh_term>Hypotension, Orthostatic</mesh_term>
    <mesh_term>Hypotension</mesh_term>
  </condition_browse>
  <intervention_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Insulin Lispro</mesh_term>
  </intervention_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03248271
org study id: H17-01663
nct id: NCT03248271
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
In this study investigator's aim to determine the impact of insulin therapy on hypotension
      and sarcopenia
Diabetes is common in the elderly. By the age of 70, approximately 25% of the population has
      diabetes and another 25% is at risk for diabetes. Elderly patients with diabetes are at
      increased risk for disability and reduction in their instrumental and basic activities of
      daily living. The prevalence of frailty is higher in people with diabetes that with age
      matched controls without diabetes. One of the major contributing factors to frailty is
      sarcopenia.

      Insulin is an important anabolic hormone that prevents protein breakdown and to a lesser
      extent stimulates protein synthesis. There is some evidence that the ability of insulin to
      stimulate anabolic processes may be reduced in diabetes.

      Insulin has cardiovascular properties, resulting in simultaneous adrenergic and vasodilatory
      responses that have opposing influences on blood pressure. Epidemiological studies have
      demonstrated that the use of insulin is a risk factor for syncope.

      The investigators will study 30 older adults age 65 and older with type 2 diabetes who have
      never taken insulin to manage their diabetes but now need insulin to manage their diabetes.
      Data will be compared pre insulin start and 3 and 6 months after starting insulin.
observational model: Cohort
time perspective: Prospective
measure: Body composition
time frame: Change from months 0, 3 and 6 months post insulin start
description: Measured by DEXA Scan
measure: Grip strength
time frame: Change from months 0, 3 and 6 months post insulin start
description: measured by Hand Dynamometer
measure: Physical functioning Survey
time frame: Change from months 0, 3 and 6 months post insulin start
description: measured by the Physical Component Summary from the SF-12 Health
measure: Presence or absence of orthostatic hypotension
time frame: Change from months 0, 3 and 6 months post insulin start
description: Drop in systolic blood pressure of greater than 20 mmHg after 3 minutes of standing
measure: Nadir of systolic blood pressure during the Tilt Table Test
time frame: Change from months 0, 3 and 6 months post insulin start
description: Lowest systolic blood pressure obtained during the Tilt Table Test
measure: Nadir of diastolic blood pressure during the Tilt Table Test
time frame: Change from months 0, 3 and 6 months post insulin start
description: Lowest diastolic blood pressure obtained during the Tilt Table Test
measure: Nadir of middle cerebral artery velocity as measured by transcranial doppler
time frame: Change from months 0, 3 and 6 months post insulin start
description: Lowest middle cerebral artery velocity obtained during the Tilt Table Test
measure: Presence or absence of a positive Tilt Table Test (vasovagal syncope)
time frame: Change from months 0, 3 and 6 months post insulin start
description: Sudden drop in blood pressure and heart rate that leads to fainting
arm group label: Type 2 Diabetes, Insulin Naive
description: Study participants will be tested prior to and 3 and 6 months after starting insulin to manage their diabetes
intervention type: Drug
intervention name: Insulin Lispro
description: Insulin
arm group label: Type 2 Diabetes, Insulin Naive
other name: Humalog
study pop: 
sampling method: Non-Probability Sample
criteria: 
gender: All
minimum age: 65 Years
maximum age: N/A
last name: Madden M Kenneth, MD
role: Principal Investigator
affiliation: University of British Columbia/Gerontology Research Lab
facility: 
country: Canada
citation: Morley JE, Malmstrom TK, Rodriguez-Manas L, Sinclair AJ. Frailty, sarcopenia and diabetes. J Am Med Dir Assoc. 2014 Dec;15(12):853-9. doi: 10.1016/j.jamda.2014.10.001. Epub 2014 Nov 20. No abstract available.
PMID: 25455530
citation: Rizzo MR, Barbieri M, Fava I, Desiderio M, Coppola C, Marfella R, Paolisso G. Sarcopenia in Elderly Diabetic Patients: Role of Dipeptidyl Peptidase 4 Inhibitors. J Am Med Dir Assoc. 2016 Oct 1;17(10):896-901. doi: 10.1016/j.jamda.2016.04.016. Epub 2016 Jun 2.
PMID: 27262494
citation: Canadian Diabetes Association Clinical Practice Guidelines Expert Committee; Meneilly GS, Knip A, Tessier D. Diabetes in the elderly. Can J Diabetes. 2013 Apr;37 Suppl 1:S184-90. doi: 10.1016/j.jcjd.2013.01.045. Epub 2013 Mar 26. No abstract available.
PMID: 24070944
citation: Leenders M, Verdijk LB, van der Hoeven L, Adam JJ, van Kranenburg J, Nilwik R, van Loon LJ. Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc. 2013 Aug;14(8):585-92. doi: 10.1016/j.jamda.2013.02.006. Epub 2013 Mar 26.
PMID: 23537893
citation: Bassil MS, Gougeon R. Muscle protein anabolism in type 2 diabetes. Curr Opin Clin Nutr Metab Care. 2013 Jan;16(1):83-8. doi: 10.1097/MCO.0b013e32835a88ee.
PMID: 23196814
citation: Salle A, Guilloteau G, Ryan M, Bouhanick B, Ritz P. Effect of insulin treatment on the body composition of Type 2 diabetic patients. Diabet Med. 2004 Dec;21(12):1298-303. doi: 10.1111/j.1464-5491.2004.01335.x.
PMID: 15569132
citation: Gin H, Rigalleau V, Perlemoine C. Insulin therapy and body weight, body composition and muscular strength in patients with type 2 diabetes mellitus. J Nutr Metab. 2010;2010:340570. doi: 10.1155/2010/340570. Epub 2009 Oct 21.
PMID: 20721344
citation: de Kanter M, Lilja B, Elmstahl S, Eriksson KF, Sundkvist G. A prospective study of orthostatic blood pressure in diabetic patients. Clin Auton Res. 1998 Aug;8(4):189-93. doi: 10.1007/BF02267780.
PMID: 9791738
citation: Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med. 2007 Oct;120(10):841-7. doi: 10.1016/j.amjmed.2007.02.023.
PMID: 17904451
citation: Vinik AI, Erbas T. Cardiovascular autonomic neuropathy: diagnosis and management. Curr Diab Rep. 2006 Dec;6(6):424-30. doi: 10.1007/s11892-006-0074-z.
PMID: 17118224
citation: Tack CJ, Lenders JW, Willemsen JJ, van Druten JA, Thien T, Lutterman JA, Smits P. Insulin stimulates epinephrine release under euglycemic conditions in humans. Metabolism. 1998 Mar;47(3):243-9. doi: 10.1016/s0026-0495(98)90251-7.
PMID: 9500557
citation: Tack CJ, Smits P, Willemsen JJ, Lenders JW, Thien T, Lutterman JA. Effects of insulin on vascular tone and sympathetic nervous system in NIDDM. Diabetes. 1996 Jan;45(1):15-22. doi: 10.2337/diab.45.1.15.
PMID: 8522054
citation: Meneilly GS, Elliott T, Battistini B, Floras JS. N(G)-monomethyl-L-arginine alters insulin-mediated calf blood flow but not glucose disposal in the elderly. Metabolism. 2001 Mar;50(3):306-10. doi: 10.1053/meta.2001.19493.
PMID: 11230783
citation: Lipsitz LA, Pluchino FC, Wei JY, Rowe JW. Syncope in institutionalized elderly: the impact of multiple pathological conditions and situational stress. J Chronic Dis. 1986;39(8):619-30. doi: 10.1016/0021-9681(86)90187-6.
PMID: 3090090
citation: Ruiz GA, Calvar C, Hermes R, Rivadeneira D, Bengolea V, Chirife R, Tentori MC, Gelpi RJ. Insulin sensitivity in young women with vasovagal syncope. Am Heart J. 2003 May;145(5):834-40. doi: 10.1016/S0002-8703(02)94707-1.
PMID: 12766740
citation: Stratton JR, Cerqueira MD, Schwartz RS, Levy WC, Veith RC, Kahn SE, Abrass IB. Differences in cardiovascular responses to isoproterenol in relation to age and exercise training in healthy men. Circulation. 1992 Aug;86(2):504-12. doi: 10.1161/01.cir.86.2.504.
PMID: 1638718
citation: Madden KM, Tedder G, Lockhart C, Meneilly GS. Euglycemic hyperinsulinemia alters the response to orthostatic stress in older adults with type 2 diabetes. Diabetes Care. 2008 Nov;31(11):2203-8. doi: 10.2337/dc08-1058. Epub 2008 Aug 20.
PMID: 18716048
citation: Sergi G, De Rui M, Stubbs B, Veronese N, Manzato E. Measurement of lean body mass using bioelectrical impedance analysis: a consideration of the pros and cons. Aging Clin Exp Res. 2017 Aug;29(4):591-597. doi: 10.1007/s40520-016-0622-6. Epub 2016 Aug 27.
PMID: 27568020
citation: Ziegler D, Laux G, Dannehl K, Spuler M, Muhlen H, Mayer P, Gries FA. Assessment of cardiovascular autonomic function: age-related normal ranges and reproducibility of spectral analysis, vector analysis, and standard tests of heart rate variation and blood pressure responses. Diabet Med. 1992 Mar;9(2):166-75. doi: 10.1111/j.1464-5491.1992.tb01754.x.
PMID: 1563252
citation: Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005 Aug 30;173(5):489-95. doi: 10.1503/cmaj.050051.
PMID: 16129869
citation: Del Rosso A, Ungar A, Bartoli P, Cellai T, Mussi C, Marchionni N, Masotti G; Gruppo Italiano di Studio Della Sincope Dell'anziano. Usefulness and safety of shortened head-up tilt testing potentiated with sublingual glyceryl trinitrate in older patients with recurrent unexplained syncope. J Am Geriatr Soc. 2002 Aug;50(8):1324-8. doi: 10.1046/j.1532-5415.2002.50351.x.
PMID: 12164986
citation: Lipsitz LA, Mukai S, Hamner J, Gagnon M, Babikian V. Dynamic regulation of middle cerebral artery blood flow velocity in aging and hypertension. Stroke. 2000 Aug;31(8):1897-903. doi: 10.1161/01.str.31.8.1897.
PMID: 10926954
responsible party type: Sponsor-Investigator
investigator affiliation: University of British Columbia
investigator full name: Kenneth Madden
investigator title: Associate Professor, UBC Department of Medicine
mesh term: Sarcopenia
mesh term: Hypotension, Orthostatic
mesh term: Hypotension
mesh term: Insulin Lispro
sharing ipd: No