Abstract
BackgroundTo compare the effects of nateglinide and rosiglitazone on inflammatory markers, GLP-1 levels and metabolic profile in patients with type 2 diabetes (DM2).MethodsA prospective study was performed in 20 patients with DM2, mean age 51.82 ± 8.05 years, previously treated with dietary intervention. Participants were randomized into rosiglitazone (4–8 mg/day) or nateglinide (120 mg 3 times a day) therapy. After 4 months, the patients were crossed-over with 8 weeks washout period to the alternative treatment for an additional 4-month period on similar dosage schedule. The following variables were assessed before and after 4 months of each treatment period: (1) a test with a standardized 500 calories meal for 5 h including frequent measurements of glucose, insulin, glucagon, proinsulin, GLP-1, free fat acids (FFA), and triglycerides levels was obtained. The lipid profile and HbA1 levels were measured at fasting. (2) Haemostatic and inflammatory markers: platelet aggregation, fibrinogen, PAI-1 activity, C reactive protein (CRP), IL-6, TNF-α, leptin, sICAM and TGFβ levels.ResultsBoth therapy decreased blood glucose levels under the postprandial curve but neither affected glucagon and GLP-1 levels. Nateglinide was associated with higher insulin and pro-insulin secretion, but similar pro-insulin/insulin ratio when compared with rosiglitazone. Only rosiglitazone decreased Homa β, PAI-1 activity, CRP, fibrinogen, TGFβ, FFA and triglyceride levels.ConclusionsNateglinide and rosiglitazone were effective in improving glucose and lipid profile and β cell function, but rosiglitazone afforded a better anti-inflammatory effect. No drug restored alpha cell sensitivity or changed GLP-1 levels. Maintenance of haemostatic factors, inflammatory factors and glucagon levels can be related to the continuously worsening of cardiovascular function and glucose control observed in DM2.
Highlights
To compare the effects of nateglinide and rosiglitazone on inflammatory markers, glucagon-like peptide-1 (GLP-1) levels and metabolic profile in patients with type 2 diabetes (DM2)
Nateglinide and rosiglitazone were effective in improving glucose and lipid profile and β cell function, but rosiglitazone afforded a better anti-inflammatory effect
Maintenance of haemostatic factors, inflammatory factors and glucagon levels can be related to the continuously worsening of cardiovascular function and glucose control observed in Type 2 diabetes mellitus (DM2)
Summary
To compare the effects of nateglinide and rosiglitazone on inflammatory markers, GLP-1 levels and metabolic profile in patients with type 2 diabetes (DM2). Cardiovascular disease is the leading cause of mortality in patients with type 2 diabetes mellitus. Rosiglitazone and nateglinide are drugs that differ in their primary mechanism of action and have been previously considered in type 2 diabetes treatment. The thiazolidinedione rosiglitazone, a peroxisome proliferator activated receptor gamma (PPARγ) agonist, is an insulin sensitizing agent that improves glycaemic control and a variety of other metabolic disturbances in patients with type 2 diabetes. The increased risk of acute myocardial infarction and a trend towards increased mortality with the drug brought concern about the safety of rosiglitazone, prompting its withdrawn of the market
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