El-Sheikh Hadier M, El-Haggar Sahar M, Elbedewy Tamer A
Clinical Pharmacy Department, College of Pharmacy, Faculty of Pharmacy, Tanta University, El- Guiesh Street, Tanta- El-Gharbia Government, 72513, Tanta, Egypt.
Internal Medicine Department, Faculty of Medicine, Tanta University, College of Medicine, El- Guiesh Street, Tanta- El-Gharbia Government, Tanta, Egypt.
Diabetes Metab Syndr. 2019 Jan-Feb;13(1):167-173. doi: 10.1016/j.dsx.2018.08.035. Epub 2018 Sep 1.
Insulin resistance (IR) is predominant in type 2 diabetic patients. This study aimed to investigate benefits from adding l-carnitine to ongoing glimepiride compared to glimepiride monotherapy on IR in diabetic patients who failed to achieve their glycemic goals on glimepiride monotherapy.
58 patients were recruited from Internal Medicine Department, Tanta University Hospital, Egypt then prospectively randomized to receive their glimepiride dose 2 mg twice daily (group 1) or glimepiride 2 mg twice daily + l-carnitine 1 g m twice daily (group 2) for 6 months. Fasting blood samples were collected at baseline, 3 and 6 months after treatment for analysis of fasting and postprandial blood glucose [FBG &PPBG], glycated hemoglobin [HbA1c %], fasting insulin, extracellular part of insulin regulated aminopeptidase [IRAPe] as a novel marker, tumor necrosis factor-alpha [TNF-α], visfatin and lipid panel. Body mass index [BMI] and homeostasis model assessment of insulin resistance [HOMA-IR] were calculated. Data were statistically analyzed by SPSS using unpaired Student's t-test and one way analysis of variance; p ≤ 0.05 was considered statistically significant.
The obtained data suggested that adding l-carnitine to glimepiride has a significantly beneficial effect on FBG, PPBG, HbA1c, fasting insulin, HOMA-IR index, IRAPe, TNF-α, visfatin and lipid panel parameters but doesn't have effect on BMI and blood pressure.
The co-administration of l-carnitine with glimepiride represents a new therapeutic strategy for better controlling diabetic patients as it resulted in more beneficial effects on direct and indirect biomarkers of insulin resistance than glimepiride alone.
胰岛素抵抗（IR）在2型糖尿病患者中较为常见。本研究旨在探讨在使用格列美脲单药治疗未能达到血糖目标的糖尿病患者中，与格列美脲单药治疗相比，在持续使用格列美脲的基础上加用左旋肉碱对IR的益处。
从埃及坦塔大学医院内科招募58例患者，然后前瞻性随机分为两组，一组每日两次服用2 mg格列美脲（第1组），另一组每日两次服用2 mg格列美脲 + 每日两次服用1 g左旋肉碱（第2组），持续6个月。在基线、治疗后3个月和6个月采集空腹血样，分析空腹和餐后血糖[FBG和PPBG]、糖化血红蛋白[HbA1c%]、空腹胰岛素、胰岛素调节氨肽酶细胞外部分[IRAPe，一种新型标志物]、肿瘤坏死因子-α[TNF-α]、内脏脂肪素和血脂指标。计算体重指数[BMI]和胰岛素抵抗稳态模型评估[HOMA-IR]。使用SPSS软件进行统计学分析，采用非配对学生t检验和单因素方差分析；p≤0.05被认为具有统计学意义。
获得的数据表明，在格列美脲基础上加用左旋肉碱对FBG、PPBG、HbA1c、空腹胰岛素、HOMA-IR指数、IRAPe、TNF-α、内脏脂肪素和血脂指标参数有显著有益影响，但对BMI和血压无影响。
左旋肉碱与格列美脲联合使用是一种更好控制糖尿病患者的新治疗策略，因为与单独使用格列美脲相比，它对胰岛素抵抗的直接和间接生物标志物产生了更有益的影响。
