Vascular Effects of Improving Metabolic Control With Metformin or Rosiglitazone in Type 2 Diabetes

Abstract

At equivalent glycemic control, rosiglitazone, but not metformin, improves endothelium dependent vasodilatation and insulin sensitivity in type 2 diabetes.

Impact of metformin versus repaglinide on non-glycaemic cardiovascular risk markers related to inflammation and endothelial dysfunction in non-obese patients with type 2 diabetes

“…For albuminuria, also an increase has been observed after metformin therapy (37). The observed lack of significant difference in the present study in the levels of IL-6, fibrinogen and adiponectin is in accordance with previous data for metformin in predominantly obese patients with T2DM (20,24,26,37,48,51). Repaglinide has been shown to decrease levels of CRP, IL-6 and PAI-1-ag (21)(22)(23)27) and either to decrease (27) or have no significant effect on levels of fibrinogen (21,52) in predominantly obese patients with T2DM.…”

“…a major precursor in the formation of AGE) and albuminuria (19,37,(45)(46)(47)(48) and either decrease (20,22,37,(49)(50)(51) or having no significant effect (19,20,24,37,50) on circulating levels of CRP, TNF-a, PAI-1-ag, t-PA-ag, sICAM-1 and sE-selectin. For albuminuria, also an increase has been observed after metformin therapy (37).…”

“…Thus, biological mechanisms both dependent and independent of glycaemia might influence the CVD biomarkers. As yet, few studies have compared the effect of various anti-hyperglycaemic treatment regimens on CVD biomarkers, and most studies were in obese patients with T2DM (17,(19)(20)(21)(22)(23)(24)(25)(26)(27).…”

Rosiglitazone improves endothelial function in patients with type 2 diabetes treated with insulin

“…4 mg/day) has been previously associated with improved endothelial function only in non-diabetic populations. 7,8 In T2DM patients, improvement in endothelial function has been demonstrated with the usual dose of 8 mg/day rosiglitazone, 5,6,10,11 while the low dose has not been previously studied in these patients. Despite the beneficial endothelial effect of rosiglitazone shown by this study in insulin-treated T2DM patients, recent meta-analyses reported a significant increase in the risk of myocardial infarction and a borderline significant rise in cardiovascular death in rosiglitazone-treated patients with T2DM, especially those treated with insulin.…”

“…3 Thiazolidinediones, rosiglitazone and pioglitazone, are oral antidiabetic agents that have been shown to improve glycaemic control by reducing insulin resistance 4 and exert beneficial effects on endothelial function. [5][6][7][8][9][10][11][12] Rosiglitazone has been reported to improve endothelial function in patients with T2DM 5,6,10 and non-diabetic populations with insulin resistance (metabolic syndrome and polycystic ovary syndrome), 7,8,11 suggesting a possible beneficial effect on cardiovascular prognosis. 3 However, recent meta-analyses have reported an increased incidence of myocardial infarction with rosiglitazone treatment, especially in patients with T2DM treated with insulin; 13,14 the effect of rosiglitazone on vascular function in this group of patients has not been studied.…”