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Original Articles

Insulin and Sulfonylurea Therapy in NIDDM Patients: Are the Effects on Lipoprotein Metabolism Different Even With Similar Blood Glucose Control?

  1. Geremia Romano,
  2. Lidia Patti,
  3. Francesca Innelli,
  4. Lucrezia Di Marino,
  5. Giovanni Annuzzi,
  6. Mario Iavicoli,
  7. Gustavo A Coronel,
  8. Gabriele Riccardi and
  9. Angela A Rivellese
  1. Department of Clinical and Experimental Medicine, Federico II University Medical School Naples
  2. Novo-Nordisk Rome, Italy
  1. Address correspondence and reprint requests to Dr. A.A. Rivellese, Department of Clinical and Experimental Medicine, Federico II University Medical School of Naples, via S. Pansini, 5, 80131 Naples, Italy.
Diabetes 1997 Oct; 46(10): 1601-1606. https://doi.org/10.2337/diacare.46.10.1601
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Abstract

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), HbA1c, 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 mmoH, 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.

  • Received September 23, 1996.
  • Revision received May 9, 1997.
  • Accepted May 9, 1997.
  • Copyright © 1997 by the American Diabetes Association
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October 1997, 46(10)
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Insulin and Sulfonylurea Therapy in NIDDM Patients: Are the Effects on Lipoprotein Metabolism Different Even With Similar Blood Glucose Control?
Geremia Romano, Lidia Patti, Francesca Innelli, Lucrezia Di Marino, Giovanni Annuzzi, Mario Iavicoli, Gustavo A Coronel, Gabriele Riccardi, Angela A Rivellese
Diabetes Oct 1997, 46 (10) 1601-1606; DOI: 10.2337/diacare.46.10.1601

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Insulin and Sulfonylurea Therapy in NIDDM Patients: Are the Effects on Lipoprotein Metabolism Different Even With Similar Blood Glucose Control?
Geremia Romano, Lidia Patti, Francesca Innelli, Lucrezia Di Marino, Giovanni Annuzzi, Mario Iavicoli, Gustavo A Coronel, Gabriele Riccardi, Angela A Rivellese
Diabetes Oct 1997, 46 (10) 1601-1606; DOI: 10.2337/diacare.46.10.1601
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