Abstract
Heart and skeletal muscle insulin resistance and abnormal myocardial flow reserve (MFR) occurs in patients with type-II diabetes. Improvement of heart and skeletal muscle insulin resistance with rosiglitazone use over 16 weeks have been reported. However, it is not clear whether chronic use of troglitazone can improve heart and skeletal muscle insulin resistance and MFR. Materials and Methods: To test the hypothesis whether effects of troglitazone on heart and skeletal muscle insulin resistance and MFR in patients with type-II diabetes, rest and dipyridamole stress perfusion positron emission tomography (PET) with 13N-ammonia and heart and skeletal muscle 18FDG PET scans under insulin clamping were undertaken before and 12 month after the initiation of troglitazone therapy (400 mg/day) in 23 patients with type-II diabetes. Twenty patients with type-II diabetes without CAD and without medications were served as controls. In controls, any medications were not added from the first PET study and 12 months after the second PET study. Results: Baseline myocardial blood flow (MBF) was comparable before and after the troglitazone group as was the controls. MBF during dipyridamole administration (0.56 mg/min/kg) was not significantly improved in troglitazone group and controls. MFR was not improved in troglitazone group and controls. In troglitazone group, whole body glucose disposal rate (GDR; μmole/min/kg) significantly improved (pre; 19.0 ± 9.55, post; 28.7 ± 15.3, p as did the skeletal muscle glucose utilization rate (SMGU (μmole/min/kg); pre; 20.3 ± 12.0, post; 34.8 ± 10.6, p insulin resistance is implicated in patients with type-II diabetes and impaired MFR is uncoupled with insulin resistance in the whole body and heart and skeletal muscle in patients with type-II diabetes.
Highlights
Insulin resistance is defined as an impaired glucose utilization response to the stimulatory effect of insulin and has been recognized to have common essential role in a variety of metabolic diseases including type-II diabetes mellitus [1]
This study aimed to study chronic effects of troglitazone therapy over 12 months, on heart and skeletal muscle insulin resistance and myocardial flow reserve (MFR) and to certify MFR in patients with type-II diabetes without coronary artery disease (CAD) is uncoupled with a recovery of insulin resistance in the whole body and heart andskeletal muscle
In control group,skeletal muscle glucose utilization (SMGU) and glucose disposal rate (GDR) were not changed 12 months after the first positron emission tomography (PET) scan. These results showed that chronic troglitazone therapy could preserve effect to improve the insulin resistance in the skeletal muscle and whole body in patients with type-II diabetes without CAD
Summary
Insulin resistance is defined as an impaired glucose utilization response to the stimulatory effect of insulin and has been recognized to have common essential role in a variety of metabolic diseases including type-II diabetes mellitus [1]. PET can be used to evaluate insulin resistance and myocardial perfusion abnormalities in subjects highly at risk for CAD. Reduced skeletal muscle glucose utilization (SMGU) under hyperinsulinemic euglycemic clamping, OPEN ACCESS. Biomedical Science and Engineering 6 (2013) 144-151 implying insulin resistance in the skeletal muscle, has been reported in patients with type-II diabetes [3,4,5]. Reduced myocardial flow reserve (MFR) in patients with type-II diabetes without evidence of CAD [6,7,8] have been reported suggesting an existence of microvascular abnormality in the heart
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