Effects Of Insulin Plus Rosiglitazone Or Insulin Plus Metformin On Serum N-terminal Pro-brain Natriuretic Peptide, Adiponectin, Leptin And CRP In Type 2 Diabetes Mellitus: A Randomized-controlled Study.

Objective: To compare the effects of insulin plus rosiglitazone with insulin plus metformin on serum N-terminal pro-brain natriuretic peptide(NT-BNP), adiponectin, leptin and C reaction protein(CRP) in type 2 diabetes mellitus. To evaluate the difference of the two kinds of therapies on waist, hip, weight, BMI and C peptide of type 2 diabetes mellitus. To explore the mechanism of fluid retention,edema and even heart failure by use of rosiglitazone plus insulin.Method: 60 type 2 diabetic patients were recruited, divided into insulin plus rosiglitazone(4mg/d) group(n = 30) and insulin plus metformin group(n = 30) randomly, the random sequence was generated by computer. The trial consisted for a 8 weeks course of treatment. The body weight, the waist, hip, ratio of waist to hip, body mass index(BMI), fasting blood glucose(FPG), postprandial blood glucose(PPG), HbA1c, C-peptide, serum NT-BNP, adiponectin, leptin and CRP were measured at beginning and end of 8 weeks. Reault: 56 type 2 diabetic patients completed the trial. Two patients in insulin plus rosiglitazone group withdrew the trial for edema at the end of 4 weeks treatment, two patients in insulin plus metformin group could not be followed at the end of the trial. Both insulin plus rosiglitazone and insulin plus metformin reduced the level of FPG, PPG and HbA₁c obviously(p<0.05). The hip, weight and BMI and the level of adiponectin increased significantly in insulin plus rosiglitazone group (p<0.05), the dosage of insulin decreased compared with the baseline(p<0.05). On the other hand, in insulin plus metformin group, compared with the baseline, the waist, hip, ratio of waist to hip, weight, BMI, the level of serum NT-BNP, adiponectin, leptin and CRP did not change apparently (P>0.05 ) , and the dosage of insulin decreased significantly also (p<0.05) . Compared with the change of absolute value in mean differences between two groups, there were remarkable differences among hip, the body weight, BMI and postprandial C peptide (p<0.05) . The frequencies of hypoglycemia onsets are not obviously difference between the two groups (p>0.05). The group of insulin plus rosiglitazone had 3 cases with edema, none with heart failure, the serum NT-BNP level did not change apparently.Conclusion: FBG, PPG and HbA1c could be improved significantly by both insulin plus rosiglitazone or insulin plus metformin on type 2 diabetic patients. The levels of serum NT-BNP, leptin and CRP did not change obviously in both 2 groups, but the level of serum adiponectin, hip, weight and BMI increased significantly in insulin plus rosiglitazone group.