Re: Glucose lowering _with drugs_ does not reduce inflammatory markers
- From: Kurt <kurtwheeling1965@xxxxxxxxxxx>
- Date: Wed, 16 Sep 2009 12:02:46 -0700 (PDT)
Still more drug peddling, despite the accumulating evidence, such as
this, that diet and lifestyle does reduce risk, while reliance on drugs
does not improve patient outcomes.
Susan
As usual your "spin" on this misrepresents the article. I suggest
people read the study below for themselves to get the point of what
they concluded. And as always, keep in mind it is but one study. I'm
also posting another take on this in a separate post.
Kurt
Insulin or Metformin Does Not Reduce Inflammatory Biomarkers
In patients with recent onset Type 2 diabetes, treatment with insulin or
the diabetes drug metformin did not reduce inflammatory biomarkers, such
as high-sensitivity C-reactive protein, although the treatment did
improve glucose control, according to a study.
As diabetes is in part an inflammatory condition, a possible therapeutic
target for patients is subclinical inflammation, a modifiable risk
factor, according to background information in the article.
"Proinflammatory mechanisms have been linked to the core metabolic
defects of beta-cell insufficiency and insulin resistance, and
elevations in levels of inflammatory biomarkers, including
high-sensitivity C-reactive protein (hsCRP), IL-6, and soluble tumor
necrosis factor receptor 2 (sTNFr2), predict incident Type 2 diabetes
among apparently healthy individuals," the authors write. Evidence is
limited on whether improvement in glycemic control, insulin resistance,
or both with antidiabetic agents such as insulin and metformin may
beneficially change inflammation.
Aruna D. Pradhan, M.D., M.P.H., of Brigham and Women’s Hospital and
Harvard Medical School, Boston, and colleagues conducted a study to
determine whether insulin alone or combined with metformin lowers levels
of hsCRP, IL-6, and sTNFr2 in patients with recent-onset Type 2 diabetes
mellitus. The study included 500 adults (median [midpoint] time from
diabetes diagnosis, 2.0 years), with suboptimal glycemic control and
elevated hsCRP levels. Participants were randomized to 1 of 4
treatments: placebo metformin only; placebo metformin and insulin;
active metformin only; or active metformin and insulin. The researchers
noted the change in the measurement of the inflammatory biomarkers from
the beginning of the trial to 14 weeks.
The authors write that, "No consistent association was found between
glucose reduction and improvement in inflammatory status ascertained by
change in levels of hsCRP, IL-6, or sTNFr2. Despite substantially
improving glucose control, neither insulin nor metformin reduced
inflammatory biomarker levels for the main effects evaluated or in
comparisons between the individual treatment groups. An interaction
between interventions was observed such that, compared with no
pharmacologic intervention, those allocated to insulin alone had a
significant attenuation of inflammation reduction, an effect not
observed among those allocated to metformin and insulin or to metformin
alone."
"From a clinical perspective, until other end-point trial data become
available, these data underscore the need to improve adherence with
therapies that do reduce cardiovascular events among diabetic patients,
including exercise; weight management; smoking cessation; blood pressure
control; and, in appropriate patients, antiplatelet and statin therapy,"
the authors conclude.
JAMA. 2009;302[11]:1186-1194.
.
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