The Effects Of Acarbose And Glimepiride On Plasma Leptin,NPY,TNF-αin Type 2 Diabetes Mellitus

Objective (1)To study the change of plasma leptin, neuropeptide Y(NPY), tumor necrosis factor- α (TNF- a )in type 2 diabetic patients. (2) To observe the effects of a -glucosidase inhibitor(Acarbose) or sulphnylurea (Glimepiride) on plasma leptin, NPY and TNF- a in type 2 diabetic patients. Methods (1) The levels of fasting and postprandial plasma glucose and insulin, HbA1c, fasting triglyceride(TG), cholesterol(Ch), high density lipoprotein cholesterol(HDL-C), leptin, NPYand TNF- a were measured in 76 type 2 diabetic patients( male 30, female 46, 56.0+7.9years, BMI 24.4 + 3.32)and 40 non-diabetic subjects controls(male 20, female 20, 54.5 ?9.8years, BMI 25.1+2.66) . (2) Diabetic patients were divided into Acarbose (43 with type 2 diabetic patients diagnosed within 4 months prior to study, 50mg, tid) or Glimeripiride(33 with 3 years duration of type 2 diabetes, this group stopped all hypoglyceamic agents 4 weeks prior to study, 2mg, qd) treatment group. The trial consisted of a 4 week equilibrated period followed by an 8 week course of treatment. The levels of plasma leptin, NPY and TNF-α were measured respectively in all subjects.Results (1) When type 2 diabetics compared with non-diabetic controls, fasting plasma glucose(FPG), 2-hr of postprandial plasma glucose (PPG), HbA1c, fasting insulin(FIns), triglyceride(TG) and cholesterol(Ch)were elevated significantly; 2-hr of postprandial insulin(PIns), HDL-C weredecreased(p<0.05). Compared with newly diagnosed type 2 diabetic groups, the level of Fins decreased and PIns was much lower singnificantly in the longer duration of type 2 diabetics, while the level of FPG and HbA,c elevated singnificantly (p<0.05). (2) In type 2 diabetics, the level of TNF- a was higher singnificantly than that of controls(p<0.05), but no difference were found of the level of NPY and leptin between diabetic group and control group(P>0.05), (3) In type 2 diabetics , the level of leptin was higher in females than in males(p<0.05). (4)After 8 weeks of treatment, FPG, PPG, HbA,c, Fins, PIns, TNF- a ,Ch and TG decreased significantly in Acarbose group(P<0.05); leptin lowered slightly, but no statistics significance(P>0.05), no change of NPY was found. (5) In Glimeripiride group, the level of FPG, PPG, HbA1c and Ch decreased markedly (P<0.05); PIns increased significantly (P<0.05); The level of leptin, NPY, TNF- a , FIns was no change. (6) There were positive relationships between leptin and FIns, PIns, BMI, TG , Fat%( P<0.05), and positive relationships between TNF- a and FPG, PPG, Ch ,TG, FIns ( P<0.05) in type 2 diabetics.Conclusion When age, gender, and BMI were matched with controls, the level of TNF- a of type 2 diabetic patients was still high, but no changes in leptin and NPY. Leptin may related to high BMI and fasting hyperinsulinemia. Acarbose may have a slight effect on decrease TNF- a . Glimeripiride may increase the 2-hr of postprandial insulin(PIns) in the type 2 diabetics with dysfunction of 3 -cell. No change of NPY and Leptin was found in the two oral hypoglyceamic agents.