Complementary insulin therapy improves blood glucose and serum lipid parameters in type 2 (non-insulin-dependent) diabetic patients. II. Effects on serum lipids, lipoproteins and apoproteins

Summary

The aim of the present study was to evaluate the effects of complementary insulin therapy, consisting of a single dose of 1 to 8 units of shortacting insulin before each meal (4-6x daily) and sometimes at 02.30 h, on concentrations of serum lipids, lipoproteins and apoproteins in type 2 (non-insulin-dependent) diabetic patients, unsatisfactorily controlled either by oral hypoglycemic agents (OHA) or by longacting insulin 1-2x daily (INS 1-2). Compared means ±SD. Patients on INS 1-2 (n=82) had better baseline glycemic control than patients on OHA (n=68) (HbA1c: 9.33±1.76% vs. 10.59±1.83%, p<0.001 and fructosamine: 3.34±0.74 mmol/l vs. 3.85±0.84 mmol/l, p<0.001) and serum triglyceride concentrations (3.03±2.05 mmol/l vs. 4.95±4.48 mmol/l, p<0.001), in spite of longer duration of diabetes (13.35±8.07 years vs. 10.1±6.9 years, p<0.001). After 8-10 weeks of complementary insulin therapy, OHA patients (n=33) improved both the glycemic control (HbA1c: 10.5±1.78% vs. 9.0±1.75%, p<0.001 and fructosamine: 4.0±0.85 mmol/l vs. 3.5±0.76 mmol/1, p<0.001) and most of the lipid parameters (decreased serum triglyceride: 5.8±5.64 mmol/l vs. 3.6±4.69 mmol/l, p<0.001, total cholesterol/HDL-cholesterol: 6.8±3.13 vs. 5.6±2.23, p<0.01 and increased HDL-cholesterol: 1.0±0.30 mmol/l vs. 1.2±0.30 mmol/l, p<0.001, apo AI: 1.6±0.26 g/l vs. 1.8+0.28 g/l, p<0.001, LpAI particles: 0.6+0.1 g/l vs. 0.7±0.12 g/l, p<0.001 and LDL-cholesterol/apo B: 2.1 ±0.67 vs. 2.7±0.67, p<0.001). In patients previously on INS 1-2x (n=34), complementary insulin therapy with reduced dose of insulin per day (49.6±22.5 U/d vs. 36.6±13.3 U/d, p<0.001) did not further improve glycemic control but improved the number of proatherogenic and antiatherogenic lipoprotein particles (decreased apo B: 1.7±0.52 g/l vs. 1.5±0.94 g/l, p<0.01, apo AI/Lp AI: 2.9+1.01 vs. 2.3±0.98, p<0.01 and increased Lp AI particles: 0.6±0.10 g/l vs. 0.7±0.12 g/1, p<0.0001); BMI also decreased (29.4±4.28kg/m² vs. 28.9±4.24 kg/m², p<0.05). These results demonstrate that complementary insulin therapy probably induces antiatherogenic lipoprotein changes in NIDDM patients previously treated by either OHA or INS 1-2x. Thus, this type of therapy should be used more often and start earlier, and should be preferred to longacting insulins. Supported by grants MZ CR IGA 1617-3 and 0715-3.

Complementary insulin therapy improves blood glucose and serum lipid parameters in type 2 (non-insulin-dependent) diabetic patients. I. Effects on blood glucose control

Key words

type 2 (non-insulin-dependent) diabetes mellitus - complementary insulin therapy - lipids - lipoproteins - apoproteins AI - B - lipoprotein particles Lp AI - lipoprotein (a)