Blood glucose lowering by means of lifestyle intervention has different effects on adipokines as compared with insulin treatment in subjects with type 2 diabetes.
OBJECTIVE
Adipokines may be important in mediating signals from adipocytes to insulin-sensitive tissue and vasculature. We studied the effect of different glucose-lowering therapies on serum levels of plasminogen activator inhibitor-1 (PAI-1), high-sensitivity C-reactive protein (hs-CRP), TNF-alpha, leptin, adiponectin and ghrelin in patients with type 2 diabetes.


METHODS
Twenty-eight patients with poorly controlled type 2 diabetes who were receiving oral hypoglycaemic agents were allocated to one of the following groups, and treated for 1 year: (1) lifestyle intervention (L); (2) insulin treatment (I); and (3) combined treatment (L+I).


RESULTS
Similar improvements in glycaemic control occurred in all three groups. There was a reduction in body weight of 3.0 kg (median) (95% CI -5.9 to -2.0) in group L, whereas in groups L+I and I body weight increased by 3.5 kg (95% CI 1.5-4.9) and 4.9 kg (95% CI -3.1 to 8.2), respectively. By trend analyses, group L had reduced levels of PAI-1 (p=0.002), hs-CRP (p<0.0001) and TNF-alpha (p=0.006), while no significant changes were observed in the levels of leptin or adiponectin. In group I, the median levels of PAI-1 (p=0.008), TNF-alpha (p=0.058) and leptin (p=0.004) increased. In the L+I group there was a reduction in PAI-1 levels (p=0.014) and an increase in levels of leptin (p<0.001). The differences in changes in the levels of PAI-1, hs-CRP, TNF-alpha and leptin between groups were also significant (all p<0.01).


CONCLUSIONS
Improvement of glycaemic control through lifestyle intervention in type 2 diabetes had more beneficial effects on adipokine levels than when the same lowering of HbA(1c) was achieved with insulin treatment.
Aas
A-M
AM
Department of Nutrition and Dietetics, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway. anne-marie.aas@akersykehus.no
Seljeflot
I
I
Torjesen
P A
PA
Diep
L M
LM
Thorsby
P M
PM
Birkeland
K I
KI
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000523:psychology* / Q000534:rehabilitation; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007301:Insect Hormones / Q000097:blood*; D007328:Insulin / Q000627:therapeutic use; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000097:blood*; D011761:Pyrrolidonecarboxylic Acid / Q000031:analogs & derivatives* / Q000097:blood; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D002784:Cholesterol; D008076:Cholesterol, HDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007301:Insect Hormones; D007328:Insulin; D009842:Oligopeptides; D011761:Pyrrolidonecarboxylic Acid; D014280:Triglycerides; C044833:adipokinetic hormone