Predictors of improved glycaemic control with rosiglitazone therapy in type 2 diabetic patients

A practical approach for the primary care physician

Yoshinori Miyazaki, Elena De Filippis, Mandeep Bajaj, Estela Wajcberg, Leonard Glass, Curtis Triplitt, Eugenio Cersosimo, Lawrence J. Mandarino, Ralph A. DeFronzo

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective - To determine predictors of improved glycaemic control in patients with type 2 diabetes mellitus during rosiglitazone therapy using basic clinical parameters that are readily available in daily clinical practice. Research design and methods - Thirty-seven type 2 diabetic patients (men/women = 18/19; age = 54±2 years; diabetes duration = 6±1 years; diet-/sulphonylurea-treated = 24/13) received a 75 g oral glucose tolerance test (OGTT) and determination of body fat before and after rosiglitazone (8 mg/day) for 12 weeks. Results - After rosiglitazone therapy, there were decreases in HbA1C (8.6±0.2 to 7.2±0.2%, p<0.0001), fasting plasma glucose (FPG) (10.6±0.3 to 8.0±0.3 mmol/L [191±6 to 145±6 mg/dL], p<0.0001), fasting plasma insulin (FPI) (108±6 to 84±6 pmol/L [18±1 to 14±1 μU/ml], p<0.05), fasting free fatty acids (FFA) (760±39 to 611±33 μEq/l, p<0.05), mean plasma glucose (PG) - OGTT (16.2±0.39 to 12.7±0.33 mmol/L [291±7 to 230±6 mg/dL], p<0.001), and mean FFA-OGTT (604±27 to 445±23 μEq/l, p<0.01) despite increases in body weight (85±2 to 88±2 kg, p<0.01) and % fat mass (37.9±2.0 to 39.5±1.9%, p<0.01). The insulinogenic index (IGI) during 0-120 minutes OGTT (IGI0-120) increased following rosiglitazone (0.19±0.03 to 0.30±0.05, p<0.01). Two different insulin sensitivity indices, calculated from PG and plasma insulin (PI) during OGTT, increased significantly: composite index of whole body insulin sensitivity (ISIcomposite): 2.3±0.3 to 3.4±0.4, p<0.05; oral glucose insulin sensitivity (OGIS): 248±5 to 294±6 ml/m2·min, p<0.001. Using clinical and laboratory variables obtained in daily clinical practice (age, gender, diabetes duration, sulphonylurea treatment, body mass index (BMI), % fat mass, fasting plasma insulin/C-peptide/FFA/lipids, IGI0-30, IGI0-120, and ISIcomposite or OGIS), stepwise regression analysis demonstrated that % fat mass (standard coefficient (S.C.) = -0.49, p=0.001) and OGIS (S.C. = 0.31, p=0.02) or ISIcomp (S.C. = 0.31, p=0.03) are significant predictors of the decrease in HbA1C after rosiglitazone (adjusted R2=0.33, p=0.0004). Conclusions - Rosiglitazone improves insulin resistance and glycaemic control in type 2 diabetes. Obesity (more body fat mass) and reduced insulin sensitivity prior to treatment are the best predictors of glycaemic response to thiazolidinedione therapy in type 2 diabetes.

Original languageEnglish (US)
Pages (from-to)28-35
Number of pages8
JournalBritish Journal of Diabetes and Vascular Disease
Volume5
Issue number1
StatePublished - Jan 2005
Externally publishedYes

Fingerprint

rosiglitazone
Primary Care Physicians
Glucose Tolerance Test
Insulin Resistance
Glucose
Fasting
Nonesterified Fatty Acids
Type 2 Diabetes Mellitus
Fats
Insulin
Therapeutics
Adipose Tissue
C-Peptide

Keywords

  • Glycaemic control
  • Insulin sensitivity
  • Rosiglitazone
  • Type 2 diabetes mellitus

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Predictors of improved glycaemic control with rosiglitazone therapy in type 2 diabetic patients : A practical approach for the primary care physician. / Miyazaki, Yoshinori; De Filippis, Elena; Bajaj, Mandeep; Wajcberg, Estela; Glass, Leonard; Triplitt, Curtis; Cersosimo, Eugenio; Mandarino, Lawrence J.; DeFronzo, Ralph A.

In: British Journal of Diabetes and Vascular Disease, Vol. 5, No. 1, 01.2005, p. 28-35.

Research output: Contribution to journalArticle

Miyazaki, Y, De Filippis, E, Bajaj, M, Wajcberg, E, Glass, L, Triplitt, C, Cersosimo, E, Mandarino, LJ & DeFronzo, RA 2005, 'Predictors of improved glycaemic control with rosiglitazone therapy in type 2 diabetic patients: A practical approach for the primary care physician', British Journal of Diabetes and Vascular Disease, vol. 5, no. 1, pp. 28-35.
Miyazaki, Yoshinori ; De Filippis, Elena ; Bajaj, Mandeep ; Wajcberg, Estela ; Glass, Leonard ; Triplitt, Curtis ; Cersosimo, Eugenio ; Mandarino, Lawrence J. ; DeFronzo, Ralph A. / Predictors of improved glycaemic control with rosiglitazone therapy in type 2 diabetic patients : A practical approach for the primary care physician. In: British Journal of Diabetes and Vascular Disease. 2005 ; Vol. 5, No. 1. pp. 28-35.
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author = "Yoshinori Miyazaki and {De Filippis}, Elena and Mandeep Bajaj and Estela Wajcberg and Leonard Glass and Curtis Triplitt and Eugenio Cersosimo and Mandarino, {Lawrence J.} and DeFronzo, {Ralph A.}",
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TY - JOUR

T1 - Predictors of improved glycaemic control with rosiglitazone therapy in type 2 diabetic patients

T2 - A practical approach for the primary care physician

AU - Miyazaki, Yoshinori

AU - De Filippis, Elena

AU - Bajaj, Mandeep

AU - Wajcberg, Estela

AU - Glass, Leonard

AU - Triplitt, Curtis

AU - Cersosimo, Eugenio

AU - Mandarino, Lawrence J.

AU - DeFronzo, Ralph A.

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N2 - Objective - To determine predictors of improved glycaemic control in patients with type 2 diabetes mellitus during rosiglitazone therapy using basic clinical parameters that are readily available in daily clinical practice. Research design and methods - Thirty-seven type 2 diabetic patients (men/women = 18/19; age = 54±2 years; diabetes duration = 6±1 years; diet-/sulphonylurea-treated = 24/13) received a 75 g oral glucose tolerance test (OGTT) and determination of body fat before and after rosiglitazone (8 mg/day) for 12 weeks. Results - After rosiglitazone therapy, there were decreases in HbA1C (8.6±0.2 to 7.2±0.2%, p<0.0001), fasting plasma glucose (FPG) (10.6±0.3 to 8.0±0.3 mmol/L [191±6 to 145±6 mg/dL], p<0.0001), fasting plasma insulin (FPI) (108±6 to 84±6 pmol/L [18±1 to 14±1 μU/ml], p<0.05), fasting free fatty acids (FFA) (760±39 to 611±33 μEq/l, p<0.05), mean plasma glucose (PG) - OGTT (16.2±0.39 to 12.7±0.33 mmol/L [291±7 to 230±6 mg/dL], p<0.001), and mean FFA-OGTT (604±27 to 445±23 μEq/l, p<0.01) despite increases in body weight (85±2 to 88±2 kg, p<0.01) and % fat mass (37.9±2.0 to 39.5±1.9%, p<0.01). The insulinogenic index (IGI) during 0-120 minutes OGTT (IGI0-120) increased following rosiglitazone (0.19±0.03 to 0.30±0.05, p<0.01). Two different insulin sensitivity indices, calculated from PG and plasma insulin (PI) during OGTT, increased significantly: composite index of whole body insulin sensitivity (ISIcomposite): 2.3±0.3 to 3.4±0.4, p<0.05; oral glucose insulin sensitivity (OGIS): 248±5 to 294±6 ml/m2·min, p<0.001. Using clinical and laboratory variables obtained in daily clinical practice (age, gender, diabetes duration, sulphonylurea treatment, body mass index (BMI), % fat mass, fasting plasma insulin/C-peptide/FFA/lipids, IGI0-30, IGI0-120, and ISIcomposite or OGIS), stepwise regression analysis demonstrated that % fat mass (standard coefficient (S.C.) = -0.49, p=0.001) and OGIS (S.C. = 0.31, p=0.02) or ISIcomp (S.C. = 0.31, p=0.03) are significant predictors of the decrease in HbA1C after rosiglitazone (adjusted R2=0.33, p=0.0004). Conclusions - Rosiglitazone improves insulin resistance and glycaemic control in type 2 diabetes. Obesity (more body fat mass) and reduced insulin sensitivity prior to treatment are the best predictors of glycaemic response to thiazolidinedione therapy in type 2 diabetes.

AB - Objective - To determine predictors of improved glycaemic control in patients with type 2 diabetes mellitus during rosiglitazone therapy using basic clinical parameters that are readily available in daily clinical practice. Research design and methods - Thirty-seven type 2 diabetic patients (men/women = 18/19; age = 54±2 years; diabetes duration = 6±1 years; diet-/sulphonylurea-treated = 24/13) received a 75 g oral glucose tolerance test (OGTT) and determination of body fat before and after rosiglitazone (8 mg/day) for 12 weeks. Results - After rosiglitazone therapy, there were decreases in HbA1C (8.6±0.2 to 7.2±0.2%, p<0.0001), fasting plasma glucose (FPG) (10.6±0.3 to 8.0±0.3 mmol/L [191±6 to 145±6 mg/dL], p<0.0001), fasting plasma insulin (FPI) (108±6 to 84±6 pmol/L [18±1 to 14±1 μU/ml], p<0.05), fasting free fatty acids (FFA) (760±39 to 611±33 μEq/l, p<0.05), mean plasma glucose (PG) - OGTT (16.2±0.39 to 12.7±0.33 mmol/L [291±7 to 230±6 mg/dL], p<0.001), and mean FFA-OGTT (604±27 to 445±23 μEq/l, p<0.01) despite increases in body weight (85±2 to 88±2 kg, p<0.01) and % fat mass (37.9±2.0 to 39.5±1.9%, p<0.01). The insulinogenic index (IGI) during 0-120 minutes OGTT (IGI0-120) increased following rosiglitazone (0.19±0.03 to 0.30±0.05, p<0.01). Two different insulin sensitivity indices, calculated from PG and plasma insulin (PI) during OGTT, increased significantly: composite index of whole body insulin sensitivity (ISIcomposite): 2.3±0.3 to 3.4±0.4, p<0.05; oral glucose insulin sensitivity (OGIS): 248±5 to 294±6 ml/m2·min, p<0.001. Using clinical and laboratory variables obtained in daily clinical practice (age, gender, diabetes duration, sulphonylurea treatment, body mass index (BMI), % fat mass, fasting plasma insulin/C-peptide/FFA/lipids, IGI0-30, IGI0-120, and ISIcomposite or OGIS), stepwise regression analysis demonstrated that % fat mass (standard coefficient (S.C.) = -0.49, p=0.001) and OGIS (S.C. = 0.31, p=0.02) or ISIcomp (S.C. = 0.31, p=0.03) are significant predictors of the decrease in HbA1C after rosiglitazone (adjusted R2=0.33, p=0.0004). Conclusions - Rosiglitazone improves insulin resistance and glycaemic control in type 2 diabetes. Obesity (more body fat mass) and reduced insulin sensitivity prior to treatment are the best predictors of glycaemic response to thiazolidinedione therapy in type 2 diabetes.

KW - Glycaemic control

KW - Insulin sensitivity

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KW - Type 2 diabetes mellitus

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