Department of Medicine, Metabolism and Endocrinology, Juntendo University School of Medicine, Tokyo, Japan.
Endocr J. 2009;56(7):911-3. doi: 10.1507/endocrj.k09e-122. Epub 2009 Jun 9.
Insulin resistance is mainly present in skeletal muscle in non-obese patients with myotonic dystrophy. Thiazolidinediones are reported to reduce insulin resistance in these patients. However, the effects of pioglitazone in overweight patients with myotonic dystrophy and type 2 diabetes mellitus have not been established. Here, we evaluated the effect of pioglitazone in two poorly-controlled over-weight diabetic patients with myotonic dystrophy. Case 1 was a 41- year-old women (BMI 27.8 kg/m(2)) with myotonic dystrophy and type 2 diabetes had been treated with 3 mg/day glimepiride and 500 mg/day metformin, but the treatment failed to achieve good glycemic control (HbA(1C) 11.8 %). Following admission to the hospital, she was treated with low-dose insulin and 30 mg/day pioglitazone. At 10 days after initiation of therapy, glycemic control was improved, serum IL-6 and hs-CRP decreased, and adiponectin level increased rapidly. Case 2 was a 47-year-old women (BMI 29.2 kg/m(2)) with myotonic dystrophy and type 2 diabetes mellitus had been treated with insulin without successful glycemic control (HbA(1C) 10.3 %). After admission, she was treated with 15 mg/day pioglitazone. This improved glycemic control, reduced daily insulin requirement, decreased IL-6 and hs-CRP levels rapidly and increased adiponectin level at 10 days after initiation of therapy. In both cases, pioglitazone rapidly improved glycemic control, enhanced adiponectin production, and reduced inflammatory cytokines. These results suggest that pioglitazone may be suitable for these patients.
胰岛素抵抗主要存在于非肥胖型肌强直性营养不良患者的骨骼肌中。噻唑烷二酮类药物据报道可降低这些患者的胰岛素抵抗。然而，吡格列酮在超重的肌强直性营养不良合并 2 型糖尿病患者中的作用尚未确定。在这里，我们评估了吡格列酮在 2 例血糖控制不佳的超重糖尿病合并肌强直性营养不良患者中的疗效。病例 1 是一位 41 岁的女性（BMI 27.8 kg/m²），患有肌强直性营养不良和 2 型糖尿病，曾接受 3 mg/天格列美脲和 500 mg/天二甲双胍治疗，但治疗未能达到良好的血糖控制（HbA1C 11.8%）。入院后，她接受了低剂量胰岛素和 30 mg/天吡格列酮治疗。在开始治疗的 10 天后，血糖控制得到改善，血清 IL-6 和 hs-CRP 下降，脂联素水平迅速升高。病例 2 是一位 47 岁的女性（BMI 29.2 kg/m²），患有肌强直性营养不良和 2 型糖尿病，曾接受胰岛素治疗但血糖控制不佳（HbA1C 10.3%）。入院后，她接受了 15 mg/天吡格列酮治疗。这改善了血糖控制，减少了每日胰岛素需求，迅速降低了 IL-6 和 hs-CRP 水平，并在开始治疗的 10 天后增加了脂联素水平。在这两种情况下，吡格列酮都迅速改善了血糖控制，增加了脂联素的产生，并减少了炎症细胞因子。这些结果表明，吡格列酮可能适合这些患者。
