Effect of insulin versus sulfonylurea therapy on cardiovascular risk factors and fibrinolysis in type II diabetes

Panahloo, Arshia; Mohamed‐Ali, Vidya; Andres, Christine; Denver, A. E.; Yudkin, John

doi:10.1016/s0026-0495(98)90023-3

Cited by 25 publications

(16 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In one study [49] insulin therapy decreased plasma PAI-1 activity in patients with type 2 diabetes without changes in glycaemic control. In another study [50] insulin therapy resulted in greater reduction in plasma PAI-1 concentrations than did SU therapy. Different insulin regimens, different effects on body weight or differences in the patient characteristics may contribute to explain the discrepant findings.…”

Section: Discussionmentioning

confidence: 94%

Blood glucose lowering by means of lifestyle intervention has different effects on adipokines as compared with insulin treatment in subjects with type 2 diabetes

Aas¹,

Seljeflot

Torjesen

et al. 2006

Diabetologia

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 94%

Blood glucose lowering by means of lifestyle intervention has different effects on adipokines as compared with insulin treatment in subjects with type 2 diabetes

Aas¹,

Seljeflot

Torjesen

et al. 2006

Diabetologia

View full text Add to dashboard Cite

“…In patients with type 2 diabetes, increased intact proinsulin levels have been associated with several cardiovascular risk markers, including increased intima-media thickness of the carotid artery (20,21), reduced fibrinolytic activity (22), and increased lipid and apolipoprotein concentrations (23). Epidemiological studies have identified intact proinsulin concentrations as an independent predictor of cardiovascular mortality (24,25).…”

Section: Discussionmentioning

confidence: 99%

Effect of Insulin Glulisine on Microvascular Blood Flow and Endothelial Function in the Postprandial State

et al. 2008

View full text Add to dashboard Cite

OBJECTIVE -To investigate the effect of insulin glulisine on postprandial microvascular blood flow in type 2 diabetes.RESEARCH DESIGN AND METHODS -A total of 15 patients with type 2 diabetes received insulin glulisine or human insulin before a liquid meal test. Thereafter, skin microvascular blood flow was measured by laser Doppler fluxmetry and blood samples were taken for measurement of plasma levels of glucose, insulin, intact proinsulin, asymmetric dimethylarginine, nitrotyrosine, interleukin-18, matrix metalloproteinase-9, oxidized LDL, and free fatty acids.RESULTS -Insulin glulisine injections resulted in higher postprandial insulin levels (means Ϯ SEM area under the curve [AUC] 0 -120 51.0 Ϯ 6.8 vs. 38.2 Ϯ 5.4 mU/l; P ϭ 0.004), while plasma glucose (AUC 0 -240 158 Ϯ 9 vs. 180 Ϯ 9 mg/dl; P Ͻ 0.05) and intact proinsulin (AUC 0 -240 26.2 Ϯ 3.5 vs. 31.2 Ϯ 4.3 pmol/l; P ϭ 0.002) were lower. Microvascular blood flow increased after insulin glulisine injection (27.9 Ϯ 3.1 to 51.7 Ϯ 9.9 arbitrary units [AU]; P Ͻ 0.05), while only a minor increase was found during human insulin (27.9 Ϯ 3.1 to 34.4 Ϯ 7.8 AU; not significant). Asymmetric dimethylarginine and nitrotyrosine levels were reduced after insulin glulisine (P Ͻ 0.05).CONCLUSIONS -Insulin glulisine is superior to human insulin in restoring postprandial metabolic and microvascular physiology. Diabetes Care 31:1021-1025, 2008S everal epidemiological studies have demonstrated an association between glucose spikes and the development of vascular complications in patients with type 2 diabetes. Postprandial generation of oxidative stress and impaired endothelial function are major contributors in the development of early vascular damage and atherosclerosis. Recent studies have shown that microvascular blood flow increases after a meal in gut, skin, heart, and adipose tissues (1-5). Postprandial regulation of microvascular blood flow is a complex process inversely affected by postprandial glucose and insulin excursions (2,6,7).Diminished prandial insulin secretion and an increase in postprandial plasma glucose excursions with increased postprandial oxidative stress and impaired endothelial function are early features of type 2 diabetes. Insulin glulisine attenuates the postprandial increase in plasma levels of intact proinsulin compared with regular human insulin, which may lead to a corresponding reduction in cardiovascular risk and ␤-cell protection. Therefore, the pharmacokinetics of prandial insulin formulations may be important not only in controlling postprandial glucose excursions, but also in the maintenance of normal endothelial function and microvascular blood flow. The aim of this study was to compare the effect of insulin glulisine with regular human insulin in terms of postprandial microvascular blood flow and several laboratory markers of endothelial function and oxidative stress in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS -This investigation wasa single-center, open-label, randomized, two-way crossover study of patients with type 2 ...

show abstract

“…Although increased insulin alone does not increase PAI-1 in normal human subjects (34), endogenous hyperinsulinemia and hyperlipidemia induced by infusion of glucose plus intralipid do (14). Others have shown that glibenclamide either increases (35) or fails to change elevated PAI-1 (36) in contrast to insulin or troglitazone, which attenuate the elevations.…”

Section: Figure 2-demonstrates Nefas and Pai-1 At Baseline And At Thementioning

confidence: 99%

Effect of Combination Glipizide GITS/Metformin on Fibrinolytic and Metabolic Parameters in Poorly Controlled Type 2 Diabetic Subjects

et al. 2002

View full text Add to dashboard Cite

OBJECTIVE -Epidemiological studies have implicated increased plasminogen-activated inhibitor 1 (PAI-1) as a marker or predictor of accelerated coronary atherosclerotic disease in type 2 diabetes. We sought to determine whether metabolic control, independent of its oral mode of implementation, affects PAI-1 in patients with marked hyperglycemia.RESEARCH DESIGN AND METHODS -A total of 91 subjects were screened, subjected to a 4-week drug washout, and randomized to daily treatment with glipizide GITS (maximum 20 mg, n ϭ 46) or metformin (maximum 2,550 mg, n ϭ 45) as monotherapy. After monotherapy, combination therapy was initiated by adding the second agent to the regimen. Plasma glucose (fasting and postprandial), HbA 1c , fructosamine, and PAI-1 were assayed before and after randomization and sequentially thereafter in all subjects; hepatic glucose output (HGO) and abdominal fat distribution were each measured in a subset of subjects.RESULTS -Glycemic control was markedly impaired at baseline (mean HbA 1c 10.4 Ϯ 0.2% glipizide GITS; 10.0 Ϯ 0.2% metformin) but improved comparably with each agent as monotherapy and in combination (P Ͻ 0.0001 vs. baseline), as assessed with meal tolerance studies, fructosamine values, and HGO. Body weight and abdominal fat distribution did not change significantly in either group. PAI-1 concentrations were extraordinarily high (5-to 10-fold more than normal) at baseline (202 Ϯ 12 ng/ml glipizide GITS; 201 Ϯ 13 ng/ml metformin) but declined comparably, and significantly, after treatment with either agent as monotherapy and decreased further with combination therapy.CONCLUSIONS -When hyperglycemia is profound, increases in PAI-1 are also profound. Control of hyperglycemia with either glipizide GITS, an insulin secretagogue, or metformin as monotherapy comparably ameliorates elevated PAI-1.

show abstract

Effect of insulin versus sulfonylurea therapy on cardiovascular risk factors and fibrinolysis in type II diabetes

Cited by 25 publications

References 30 publications

Blood glucose lowering by means of lifestyle intervention has different effects on adipokines as compared with insulin treatment in subjects with type 2 diabetes

Blood glucose lowering by means of lifestyle intervention has different effects on adipokines as compared with insulin treatment in subjects with type 2 diabetes

Effect of Insulin Glulisine on Microvascular Blood Flow and Endothelial Function in the Postprandial State

Effect of Combination Glipizide GITS/Metformin on Fibrinolytic and Metabolic Parameters in Poorly Controlled Type 2 Diabetic Subjects

Contact Info

Product

Resources

About