Effect of Insulin and Sulfonylurea Therapy, at the Same Level of Blood Glucose Control, on Low Density Lipoprotein Subfractions in Type 2 Diabetic Patients

Abstract

The aim of this study was to evaluate the effect of sc insulin (INS) compared with sulfonylurea (SUL) therapy, at the same level of blood glucose control, on the low density lipoprotein (LDL) subfraction profile in normolipidemic type 2 diabetic patients. Nine normolipidemic type 2 diabetic men (age, 56+/-3 yr; body mass index, 26.5+/-0.9 kg/m2; mean +/- SEM), after a 3-week wash-out period, were assigned to INS or SUL for 2 months in a randomized cross-over design. Doses were adjusted only during the first month and then were kept constant. At the end of the treatments, hemoglobin A1c, plasma lipids, LDL, and very low density lipoprotein (VLDL) subfraction profiles and plasma postheparin lipoprotein lipase and hepatic lipase (HL) activities were evaluated. Despite glucose control was similar at the end of both periods (hemoglobin A1c, 7.4+/-0.3% vs. 7.0+/-0.2%, INS vs. SUL), INS compared with SUL significantly reduced plasma triglyceride (0.9+/-0.1 vs. 1.1+/-0.1 mmol/L; P < 0.05). Although INS did not affect the LDL concentration, it induced a decrease in both the amount (59.0 = 9.8 vs. 76.1+/-16.8 mg/dL; P = NS) and the proportion (31.2+/-3.0% vs. 38.3+/-3.8%; P < 0.03) of small LDL. Moreover, the decrease in small LDL was positively related to the reduction of large VLDL (r = 0.67; P < 0.04) and HL (r = 0.69, P < 0.05) induced by insulin therapy. In conclusion, sc insulin therapy, independently of glucose control and even in the presence of quite low plasma triglyceride levels, is able to reduce small LDL particles in type 2 diabetic patients. This change is related to decreases in both HL activity and large VLDL particles.

Profiles of Liver Function Tests among Type 2 Diabetic Patients Who are Receiving Different Anti-Diabetic Drugs Attending Tikur Anbessa Specialized Hospitals

“…But, the present work is not in agreement with their report lowered LDL and HDL in glibenclamide received group than insulin group. The present results also in agreement with the study reported by Rivellese et al [16] that showed insulin therapy compared with glibenclamide is associated with decreases in plasma triglyceride, but not in agreement with their report on the increased level of high density lipoprotein in insulin therapy and no change in low density lipoprotein. It could be suggested that non-compliance of the patients with reference to insulin therapy.…”

“…Rivellese et al [16] found that insulin therapy compared with glibenclamide is associated with greater decreases in plasma triglyceride, very low density lipoprotein, increases in the high density lipoprotein and no change in low density lipoprotein.…”

The Effect of PPARγ-Agonism on LDL Subclass Profile in Patients with Type 2 Diabetes and Coronary Artery Disease

“…Poor glycemic control has been linked to the increased amount of small-LDL particles and a shift to the preponderance of large-LDL particles has been observed with improved glycemic control [24]. In contrast, Rivellese and associates have shown that changes in the lipoprotein profile are independent of changes in glycemic control achieved by different antidiabetic medications [25]. We found that rosiglitazone therapy modestly, but significantly, improved glycemic control with the simultaneous changes in the LDL subclass profile.…”

Differential lipid profile and hormonal response in type 2 diabetes by exogenous insulin aspart versus the insulin secretagogue repaglinide, at the same glycemic control

“…This goal was achieved as the 24-h blood glucose profiles obtained were similar and there was no significant difference in A1c. While a few studies have been performed comparing effects of insulin treatment with oral hypoglycaemic agents during similar glycaemic control [15,16], this is the first study comparing these rapid-acting treatments with main effects in the postprandial phase. We found differences in a number of variables including lipid metabolism and the IGF-system.…”

“…Improving glycaemic control by exogenous insulin in patients with type 2 diabetes and insufficient glycaemic control on treatment with oral hypoglycaemic agent alters the lipoprotein profile towards a less atherogenic pattern [13,14]. Independent of glycaemic control the mode of treatment, insulin secretagogue versus exogenous insulin, may alter the lipoprotein profile possibly by affecting portal insulin delivery to the liver [15][16][17]. This can also have importance for the GH-IGF axis [18], since insulin up regulates the GHR and GHBP level in the liver and down regulates the production of IGFBP-1 [19][20][21][22].…”