الفهرس | Only 14 pages are availabe for public view |
Abstract Insulin resistance and Type 2 diabetes mellitus (T2DM) have been recognized to be strongly linked years ago. Insulin resistance is not only the most powerful predictor of future development of T2DM; it is also a therapeutic target once hyperglycemia is present. Most T2DM patients are treated with sulfonylureas but many of them fail to achieve control on insulin resistance state and hyperglycemia with sulfonylureas monotherapy. Therefore, they usually need either to increase the dose, add some drugs increasing receptors sensitivity to insulin or finally add insulin therapy. Although several previous reports showed that L-carnitine lowered blood glucose serum levels in T2DM patients, it remains undetermined whether addition of L-carnitine to ongoing sulfonylureas therapy is more effective than sulfonylureas monotherapy for reducing insulin resistance and improving glycemic state. This study aimed at investigating the efficacy of adding Lcarnitine to ongoing glimepiride therapy compared to glimepiride monotherapy in T2DM patients and to assess the effects of both treatment modalities on blood glucose levels, glycated hemoglobin (HbA1c), fasting insulin, extracellular part of insulin regulated aminopeptidase (IRAPe) as a novel marker of insulin resistance, tumor necrosis factor-alpha (TNF-α), visfatin and lipid profile. Fifty eight eligible patients were recruited and prospectively randomized to receive glimepiride 4 mg/day alone (group 1, n = 27), or glimepiride 4 mg/day plus L-canitine 2 gm/day (group 2, n = 31) for 6 months. Fasting blood sample was obtained before, 3 and 6 months after treatment for biochemical analysis of fasting and Abstract X postprandial blood glucose (FBG &PPBG), HbA1C, fasting insulin, IRAPe, TNF-α, visfatin and lipid panel. Body mass index (BMI) and homeostasis model assessment of insulin resistance (HOMA-IR index) were also calculated. Systolic and diastolic blood pressures (SBP & DBP) were also evaluated. Data were statistically analyzed by unpaired Student’s t test and one way analysis of variance. P < 0.05 was considered statistically significant. The obtained data showed that adding L-carnitine 1 gm twice daily as adjuvant therapy to glimepiride has a significantly beneficial effect on FBG, PPBG, HbA1C, fasting insulin, HOMA-IR index, IRAPe, TNF-α, visfatin and whole lipid panel parameters but didn’t show any beneficial effect on SBP, DBP and BMI. It can be concluded that, adding L-carnitine 2 gm/day to glimepiride 4 mg/day can be a better choice than increasing glimepiride dose or addition of insulin therapy in improving insulin sensitivity; glycemic control; and lipid profile in diabetic patients who couldn’t achieve their therapeutic treatment goals with glimepiride monotherapy. |