title: Differential effects of insulin sensitization and insulin provision treatment strategies on concentrations of circulating adipokines in patients with diabetes and coronary artery disease in the BARI 2D trial.
abstract: OBJECTIVE
  To determine the effects of insulin sensitization (IS) and insulin provision (IP) treatment strategies on adipokines associated with cardiovascular disease in patients with type 2 diabetes mellitus and coronary artery disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial (BARI 2D).
  
  
  RESULTS
  Changes in adipokine levels were compared in patients with type 2 diabetes mellitus and coronary artery disease randomized to IS (n = 1037) versus IP (n = 1019) treatment strategies in BARI 2D. Circulating concentrations of leptin, adiponectin, monocyte chemoattractant protein-1, tumor necrosis factor-alpha, interleukin 6 and C-reactive protein were evaluated at baseline and one year. IS and IP treatment strategies exerted significant (p < 0.0001) differential effects on: leptin (IS: 0.02% decrease, p = 0.01; IP: 13% increase, p < 0.0001); adiponectin (IS: 73% increase, p < 0.0001; IP: no change, p = 0.52); interleukin 6 (IS: 14% decrease, p < 0.0001; IP: no change, p = 0.68). Changes in monocyte chemoattractant protein-1 and tumor necrosis factor-alpha were not statistically different between groups. C-reactive protein decreased, but the effect was significantly greater in the IS group (-32%, p < 0.0001) than in the IP group (-5%, p = 0.0005).
  
  
  CONCLUSIONS
  The IS and IP treatment strategies exerted divergent effects on adipokine and inflammatory profile in patients with type 2 diabetes mellitus and coronary artery disease. The IS treatment strategy-induced changes may be more favorable than the IP treatment strategy regarding cardiovascular pathophysiology.
authors: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, USA Pfizer Global Research & Development, Pfizer Inc., Groton, USA Robert.Wolk@pfizer.com.
authors: Robert
authors: R
authors: Wolk
authors: University of Pittsburgh, USA.
authors: Marnie
authors: M
authors: Bertolet
authors: University of Pittsburgh, USA.
authors: Maria M
authors: MM
authors: Brooks
authors: Florida Hospital Diabetes and Translational Research Institutes, Orlando, USA.
authors: Richard E
authors: RE
authors: Pratley
authors: University of Vermont, Burlington, USA.
authors: Burton E
authors: BE
authors: Sobel
authors: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, USA.
authors: Robert L
authors: RL
authors: Frye
authors: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, USA.
authors: Prachi
authors: P
authors: Singh
authors: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, USA.
authors: Andrew D
authors: AD
authors: Calvin
authors: Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, UK Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK.
authors: Martin K
authors: MK
authors: Rutter
authors: Division of Endocrinology, Diabetes and Metabolism, College of Medicine-Jacksonville, University of Florida, USA.
authors: Arshag D
authors: AD
authors: Mooradian
authors: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, USA.
authors: Virend K
authors: VK
authors: Somers
mesh_terms: D054392:Adipokines / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D018836:Inflammation Mediators / Q000097:blood*; D007328:Insulin / Q000097:blood / Q000627:therapeutic use*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D054392:Adipokines; D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D018836:Inflammation Mediators; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Diabetes mellitus; adipokines; coronary disease; risk factors