Abstract
Insulin resistance and endothelial dysfunction which shares multiple signaling pathways like hyperinsulinemia, glucotoxicity and inflammation in type 2 Diabetes Mellitus (DM) leads to several micro and macrovascular complications. Studies have shown the anti-inflammatory effects of certain oral hypoglycemic agents which will be helpful in preventing the impact of diabetes related complications. The study aimed to compare the anti-inflammatory effects of Sitagliptin and Acarbose in combination with Metformin and Sulfonylurea in Type 2DM patients by using Anti-inflammatory markers Interleukin-6 (IL6), high sensitive C-reactive protein (hsCRP) and also to compare the clinical outcome between these two groups by using the parameters Fasting blood sugar (FBS), Post prandial blood sugar (PPBS), hemoglobin A1c (HbA1C), Plasma Insulin. In this open labeled prospective parallel group clinical study 30 type 2 diabetes patients on Metformin and Sulfonylurea combination, with HbA1c value ≥7.5 were recruited in tertiary care hospital and divided into two groups based on their HbA1C levels and were added on either Acarbose or Sitagliptin along with Metformin Sulfonylurea combinations and were followed for 3 months. Parameters like FBS, PPBS, HbA1c, Plasma Insulin hsCRP, IL-6were measured before and after the study. In the study the mean value of FBS, PPBS, HbA1c, Plasma Insulin, Insulin Resistance, hsCRP were reduced in both Sitagliptin and Acarbose group, which were similar to the results of previous studies except IL6 which got reduced in Sitagliptin group but increased in Acarbose group. The study had showed the synergism of Sitagliptin with Metform in Sulfonylurea combinationin reducing inflammation however; still long term studies are required to confirm their anti-inflammatory effects.
Highlights
Diabetes mellitus is one of the non communicable diseases which have become a major global health problem[1] This is mainly due to insulin resistance or decreased production of insulin
In the earlier stages of diabetes, glucose tolerance is found to be normal, because pancreatic beta cell gives a compensatory increase in insulin output which further leads to insulin resistance after a certain period of time leading to a state called Impaired Glucose Tolerance (IGT), where there will be high postprandial glucose level
50% were in between 0-5 years, 37% of patients were between 6-10 yrs, and 13% of patients were beyond 11years of duration of Diabetes Mellitus (DM) .This mainly implied the chronicity and progression of disease pattern in those study participants
Summary
Diabetes mellitus is one of the non communicable diseases which have become a major global health problem[1] This is mainly due to insulin resistance or decreased production of insulin. In the earlier stages of diabetes, glucose tolerance is found to be normal, because pancreatic beta cell gives a compensatory increase in insulin output which further leads to insulin resistance after a certain period of time leading to a state called Impaired Glucose Tolerance (IGT), where there will be high postprandial glucose level. PKC modifies the gene transcription of endothelial cells[12] Endothelial dysfunction presents in patients with insulin resistance in stages prior to the development of impaired glucose tolerance (IGT) and type 2 DM. This suggests that insulin resistance is key factor and endothelial dysfunction is not a result of hyperglycemia
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