The lipoprotein profile differs during insulin treatment alone and combination therapy with insulin and sulphonylureas in patients with Type 2 diabetes mellitus

Authors: Lindström T.; Nyström F.H.; Olsson A.G.; Ottosson A.-M.; Arnqvist H.J.

Source: Diabetic Medicine, Volume 16, Number 10, October 1999 , pp. 820-826(7)

Publisher: Wiley-Blackwell

Abstract:

Aims To study whether changes in endogenous insulin secretion at the same glycaemic control affect the plasma concentrations of lipoproteins in patients with Type 2 diabetes mellitus.

Methods Fifteen patients, age 59 ± 2 years (mean ± sem), body weight 86.3 ± 3.0 kg, body mass index 29.6 ± 0.9 kg/m² were treated with sulphonylurea and insulin in combination or with insulin alone in a randomized, double-blind, crossover study. All patients were treated with a multiple daily injection regimen with the addition of glibenclamide 10.5 mg daily or placebo tablets.

Results During combination therapy, the dose of insulin was 25% less (P < 0.002) and there was a 29% increase in plasma C-peptide concentration (P = 0.01). Plasma levels of free insulin were not changed. Plasma levels of sex hormone-binding globulin (SHBG) and insulin-like growth factor-binding protein (IGFBP)-1 were lowered. There were no differences in the 24-h blood glucose profiles or HbA_1c (6.0 ± 0.2 vs. 6.3 ± 0.2%; P = 0.16). Body weight was similar. There was a significant decrease in plasma LDL cholesterol (3.04 ± 0.24 vs. 3.41 ± 0.21 mmol/l; P = 0.04), apolipoprotein A1 and of lipoprotein(a) but an increase in VLDL-triglycerides (1.36 ± 0.31 vs. 0.96 ± 0.16 mmol/l; P = 0.02) during combination therapy. The ratio between LDL cholesterol and apolipoprotein B concentrations was significantly lower during combination therapy (P < 0.01).

Conclusions Combination therapy with insulin and sulphonylureas increases portal insulin supply and thereby alters liver lipoprotein metabolism when compared with insulin therapy alone.

Keywords: IGFBP-1; insulin; lipoproteins; non-insulin-dependent; sulphonylurea

Language: English

Document Type: Research article

Publication date: 1999-10-01

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• In this Subject: Internal Medicine
• By this author: Lindström T. ;  Nyström F.H. ;  Olsson A.G. ;  Ottosson A.-M. ;  Arnqvist H.J.

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