Derosa Giuseppe, Salvadeo Sibilla A T, D'Angelo Angela, Fogari Elena, Ragonesi Pietro D, Ciccarelli Leonardina, Piccinni Mario N, Ferrari Ilaria, Gravina Alessia, Maffioli Pamela, Cicero Arrigo F
Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
Arch Med Res. 2008 May;39(4):412-9. doi: 10.1016/j.arcmed.2007.12.009. Epub 2008 Mar 10.
Few studies have directly compared rosiglitazone and metformin effects on adipocytokines. The aim was to observe the possible effects of rosiglitazone and metformin on glycemic control, insulin sensitivity, plasma leptin (pL), adiponectin (ADN), tumor necrosis factor-alpha (TNF-alpha), and resistin (R) in overweight and obese diabetic patients intolerant to metformin.
Six hundred and ninety-four consecutive overweight and obese type 2 diabetic patients were evaluated and 56 patients were intolerant to metformin at maximum dosage. We added rosiglitazone to metformin in these intolerant patients (RM) and we compared them with 61 patients treated with metformin (M) in a single-blind placebo-controlled trial. We evaluated body mass index (BMI), glycated hemoglobin (HbA(1c)), fasting plasma glucose (FPG), fasting plasma insulin (FPI), pL, ADN, TNF-alpha, and R at baseline and after 3 and 6 months. Furthermore, we calculated insulin resistance index (HOMA-index) using FPG and FPI.
Glycated hemoglobin, FPG, FPI, and HOMA-index results were lower than baseline values in RM and M groups. Glycated hemoglobin and HOMA-index values were significantly lower in RM group compared to M group at 6 months. Plasma leptin, ADN, TNF-alpha, and R were significantly improved in RM group compared to M group at 6 months.
No BMI change was observed, probably because rosiglitazone was added to metformin, that could mitigate the body increase of rosiglitazone. Rosiglitazone improved glycemic control and insulin resistance-correlated parameters when added to intolerant metformin patients. These data suggest that rosiglitazone may be the drug of choice for the treatment of overweight and obese type 2 diabetic patients.
很少有研究直接比较罗格列酮和二甲双胍对脂肪细胞因子的影响。目的是观察罗格列酮和二甲双胍对超重及肥胖且不耐受二甲双胍的糖尿病患者血糖控制、胰岛素敏感性、血浆瘦素（pL）、脂联素（ADN）、肿瘤坏死因子-α（TNF-α）和抵抗素（R）的可能影响。
对694例连续的超重及肥胖2型糖尿病患者进行评估，其中56例患者在最大剂量使用二甲双胍时不耐受。在这些不耐受的患者中，我们将罗格列酮添加到二甲双胍中（RM组），并在一项单盲安慰剂对照试验中将他们与61例接受二甲双胍治疗的患者（M组）进行比较。我们在基线以及3个月和6个月后评估体重指数（BMI）、糖化血红蛋白（HbA1c）、空腹血糖（FPG）、空腹血浆胰岛素（FPI）、pL、ADN、TNF-α和R。此外，我们使用FPG和FPI计算胰岛素抵抗指数（HOMA指数）。
RM组和M组的糖化血红蛋白、FPG、FPI和HOMA指数结果均低于基线值。在6个月时，RM组的糖化血红蛋白和HOMA指数值显著低于M组。与M组相比，RM组在6个月时血浆瘦素、ADN、TNF-α和R有显著改善。
未观察到BMI变化，可能是因为罗格列酮添加到二甲双胍中，这可能减轻了罗格列酮引起的体重增加。当添加到不耐受二甲双胍的患者中时，罗格列酮改善了血糖控制和胰岛素抵抗相关参数。这些数据表明，罗格列酮可能是治疗超重及肥胖2型糖尿病患者的首选药物。
