According to a study, treatment with insulin or the diabetes drug metformin did not reduce inflammatory biomarkers in patients with recent onset type 2 diabetes, although the treatment did improve glucose control.
As diabetes is in part an inflammatory condition, a possible therapeutic target for diabetes patients is subclinical inflammation, a modifiable risk factor.
Pro inflammatory 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 researchers conducted a study to determine whether insulin alone or combined with metformin lowers levels of inflammatory biomarkers hsCRP, IL-6, and sTNFr2 in patients with recent-onset type 2 diabetes mellitus. The study included 500 adults 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.
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.
The study concluded that in patients with recent-onset type 2 diabetes, treatment with insulin or metformin compared with placebo did not reduce inflammatory biomarker levels despite improving glucose control.
“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 diabetes patients, including exercise, weight management, smoking cessation and blood pressure control” the study authors add.
References:
1. Aruna D. Pradhan, et al. Effects of Initiating Insulin and Metformin on Glycemic Control and Inflammatory Biomarkers Among Patients With Type 2 Diabetes. JAMA. 2009;302(11):1186-1194.
