Diabetes, Vol 46, Issue 10 1601-1606, Copyright © 1997 by American Diabetes Association

ARTICLES

Insulin and sulfonylurea therapy in NIDDM patients. Are the effects on lipoprotein metabolism different even with similar blood glucose control?

G Romano, L Patti, F Innelli, L Di Marino, G Annuzzi, M Iavicoli, GA Coronel, G Riccardi and AA Rivellese
Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy.

This study evaluates the effects of insulin versus glibenclamide on lipoprotein metabolism at comparable levels of blood glucose control, in particular on the concentration and distribution of VLDL subfractions and lipolytic enzyme activities in nine NIDDM men (aged 56 +/- 3 years, BMI 26.5 +/- 0.9 kg/m2) (means +/- SE) participating in a crossover study. After a 3-week washout period, patients were randomly assigned to 2-month treatment periods (insulin or glibenclamide); thereafter, each patient crossed to the other treatment. At the end of each period, mean daily blood glucose (MDBG), HbA1e, plasma lipids, lipoproteins (VLDL, LDL, HDL), lipoprotein subfractions (VLDL1, 2, 3; HDL2, HDL3), and post-heparin lipase activities (lipoprotein lipase [LPL], hepatic lipase [HL]) were evaluated. Although glucose control was similar at the end of both periods (MDBG 8.3 +/- 0.3 vs. 7.9 +/- 0.3 mmol/l; HbA1c 7.4 +/- 0.3 vs. 7.0 +/- 0.2%, insulin versus glibenclamide), insulin compared with glibenclamide induced a significant reduction in plasma triglycerides (0.9 +/- 0.1 vs. 1.1 +/- 0.1 mmol/l, P < 0.05), VLDL triglycerides (50.1 +/- 12.2 vs. 63.6 +/- 12.3 mg/dl, P < 0.02), VLDL1 lipid concentration (24.9 +/- 7.5 vs. 39.9 +/- 9.5 mg/dl, P < 0.006), and increased HDL2 cholesterol (25.2 +/- 1.6 vs. 20.3 +/- 1.3 mg/dl, P < 0.03). In terms of VLDL percentage subfraction distribution, with insulin, there was a decrease in the larger subfractions (VLDL1 26.5 +/- 3.0 vs. 37.8 +/- 3.4%, P < 0.02) and an increase in the smallest (VLDL3 47.3 +/- 3.8 vs. 37.3 +/- 3.3%, P < 0.05). Moreover, HL activity was significantly lower after insulin than after glibenclamide (HL 247.2 +/- 22.3 vs. 263.5 +/- 22.6 mU/ml, P < 0.05). In conclusion, compared with glibenclamide, insulin treatment (independent of variations in glucose control) is able to decrease significantly plasma triglycerides, to increase HDL2 cholesterol, and to reduce only the concentration of the larger VLDL subfractions, with a consequent redistribution of their profile.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				P. Gomez, F. Perez-Jimenez, C. Marin, J. A. Moreno, M. J. Gomez, C. Bellido, P. Perez-Martinez, F. Fuentes, J. A. Paniagua, and J. Lopez-Miranda The -514 C/T polymorphism in the hepatic lipase gene promoter is associated with insulin sensitivity in a healthy young population J. Mol. Endocrinol., April 1, 2005; 34(2): 331 - 338. [Abstract] [Full Text] [PDF]

				G. Annuzzi, C. De Natale, C. Iovine, L. Patti, L. Di Marino, S. Coppola, S. Del Prato, G. Riccardi, and A. A. Rivellese Insulin Resistance Is Independently Associated With Postprandial Alterations of Triglyceride-Rich Lipoproteins in Type 2 Diabetes Mellitus Arterioscler. Thromb. Vasc. Biol., December 1, 2004; 24(12): 2397 - 2402. [Abstract] [Full Text] [PDF]

				D. E. DeWitt and I. B. Hirsch Outpatient Insulin Therapy in Type 1 and Type 2 Diabetes Mellitus: Scientific Review JAMA, May 7, 2003; 289(17): 2254 - 2264. [Abstract] [Full Text] [PDF]

				A.-Y. Tu and J. J. Albers Glucose Regulates the Transcription of Human Genes Relevant to HDL Metabolism: Responsive Elements for Peroxisome Proliferator-Activated Receptor Are Involved in the Regulation of Phospholipid Transfer Protein Diabetes, August 1, 2001; 50(8): 1851 - 1856. [Abstract] [Full Text] [PDF]

				A. A. Rivellese, L. Patti, G. Romano, F. Innelli, L. Di Marino, G. Annuzzi, M. Iavicoli, G. A. Coronel, and G. Riccardi Effect of Insulin and Sulfonylurea Therapy, at the Same Level of Blood Glucose Control, on Low Density Lipoprotein Subfractions in Type 2 Diabetic Patients J. Clin. Endocrinol. Metab., November 1, 2000; 85(11): 4188 - 4192. [Abstract] [Full Text]

				J. Pihlajamaki, L. Karjalainen, P. Karhapaa, I. Vauhkonen, M.-R. Taskinen, S. S. Deeb, and M. Laakso G-250A Substitution in Promoter of Hepatic Lipase Gene Is Associated With Dyslipidemia and Insulin Resistance in Healthy Control Subjects and in Members of Families With Familial Combined Hyperlipidemia Arterioscler. Thromb. Vasc. Biol., July 1, 2000; 20(7): 1789 - 1795. [Abstract] [Full Text] [PDF]

				K. Malmberg, A. Norhammar, H. Wedel, and L. Ryden Glycometabolic State at Admission: Important Risk Marker of Mortality in Conventionally Treated Patients With Diabetes Mellitus and Acute Myocardial Infarction : Long-Term Results From the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) Study Circulation, May 25, 1999; 99(20): 2626 - 2632. [Abstract] [Full Text] [PDF]