Effects Of Pioglitazone On Insulin Resistance And Blood Vessel Endothelium Function In Patients With Newly Diagnosed Type 2 Diabetes

Objective:Insulin resistance is an important reason of Type 2 diabetes,and vasculopathy always leads to the death of diabetic.It is known that homeostasis model assessment-insulin resistance index(HOMA-IR),Resistin and Adiponectin (ADPN)are the major correlation factor of resistance and blood vessel endothelium function.Peroxisome proliferators-activated receptor-gamma(PPARγ) is the regulator of insulin sensitivity and insulin resistance,which is the target molecule of euglycemic agent thiazolidinediones(TZDs).Hence in this study, HOMA-IR,Resistin,ADPN and Triglyceride(TG),Total cholesterol(TC), High density lipoprotein-cholesterol(HDL-C),Low density lipoprotein-cholesterol (LDL-C)were measured to observe the role of insulin resistance on initial Type 2 diabetes mellitus and the effection of Pioglitazone on blood vessel endothelium function of diabetics.Method:1.All thehundred sisty nine newly diagnosed Type 2 diabetic patients were devided to teo groups:observation group(femal:42,male:44)and control group(female: 43,male:40).All subjects were blood sampled and following parameters were measured:blood pressure,body weight index(BMI),waist/hip ratio(WHR), fasting blood glucose(FBG),postal glucose(PBG),fasting blood insulin(FINS), postal blood insulin,glycosylated hemoglobin(HbA1c),TG,TC,resistin and ADPN.All the above parameters were determined again after Pioglitazone were administered on 30 mg per day in observation group and Acarbose 150 mg per day or Voglibose 0.6mg per day were administered in conrol group for 18 weeks.2.Insulin resistance level was measured by HOMA-IR:HOMA-IR=fasting serum insulin[uU/ml]×fasting blood glucose[mmoL/L]/22.5. 3.Serum resistin were detected with method of double antibody ELISA(enzyme linked immunosorbent assay),and serum adiponectin was detected with method of IRMA(Immunoradiometric assay),and serum insulin was detected by RIA(Radioimmunoassay),blood glucose was determined by xidase method,and blood fat were detected with enzymic method.4.The comparison of therapeutic effect by Paired samples T Test and correlation analysis of parameters were statistically analyz with SPSS11.5.Results:1.In observation group:After treated with Pioglitazone,SBP,DBP,BMI,FPG, 2hPG,FINS,2Fins,HbA1c,TG,TC,LDL-C,HOMA-IR,Resistin were significantly lower than pretheraphy(P＜0.05),and HDL-C and ADPH were significantly higher than pretheraphy(P＜0.05);In control group:There were only 2hPG,HbA1c significantly lower than pretheraphy(P＜0.05).After treated with different oral antidiabetic drug,,SBP,DBP,FPG,HbA1c,FINS,2hINS,HOMA-IR,HDL,LDL,resistin,ADPH were significantly lower in observation group than these in control group(P＜0.05).2.HOMA-IR correlated positively with waistline,SBP,DBP,BMI,BF%,TC,TG,LDL-C,HbA1c,FPG,2hPG,FINS,2hINS and Resistin(P＜0.05),but negatively with.HDL-C,ADPN(P＜0.05).3.Resistin correlated positively with BMI,BF%,FPG,FINS,2hINS,HOMA-IRand TNF-α(P＜0.05).4There was no correlation between waist line,SBP,DBP,BMI,BF%,FPG,2hPG,FINS,2hINS,TG,TC,HDL-C,LDL-C and TNF-α(P＞0.05),meanwhile TNF-αcorrelated positively with HOMA-IR and Resistin(P＜0.05).5.ADPN correlated negatively with waist line,SBP,BMI,LDL-C,FINS and HOMA-IR(P＜0.05),but positively with HDL-C(P＜0.05),and there was no relation between ADPN and DBP,BF%,FPG,2hPG,2hINS,TC,TG,HbA1c,TNF-α(P＞0.05).Conclution:1.In diabetic,Resistin and TNF-αcorrelated negatively with insulin resistance index, which menans the two factors can lead to insulin resistance.We can say that the BMI and body fat content of diabetic larger,the level of resistin and THF-a higher.2.ADPN negatively with insulin resistance index,and it is an independent effected fator of insulin resistance.3.After administered with Pioglitazone for 18 weeks,the insulin resistance index and retum resistance of the diabetics descend,but ADPN increase.It is concluded that Pioglitazone can increase insulin sensitivity by altering level of many key fators such as ADPN and resistin.Otherwise,Pioglitazone can decrease the morbidity rate of diabetic vasculopathy by effecting lipid metabolism and blood pressure.