title: Triglyceride High-Density Lipoprotein Ratios Predict Glycemia-Lowering in Response to Insulin Sensitizing Drugs in Type 2 Diabetes: A Post Hoc Analysis of the BARI 2D.
abstract: Glycemic management is central in prevention of small vessel and cardiovascular complications in type 2 diabetes. With the plethora of newer medications and recommendations for a patient centered approach, more information is necessary to match the proper drug to each patient. We showed that BARI 2D, a five-year trial designed to compare two different glycemic treatment strategies, was suitable for assessing different responses according to different phenotypic characteristics. Treatment with insulin sensitizing medications such as thiazolidinediones and metformin was more effective in improving glycemic control, particularly in the more insulin resistant patient, when compared to the insulin provision strategy using insulin and or sulfonylureas. Triglyceride and high density lipoprotein ratio (TG/HDL-cholesterol ratio) was found to be a readily available and practical biomarker that helps to identify the insulin resistant patient. These results support the concept that not all medications for glycemic control work the same in all patients. Thus, tailored therapy can be done using phenotypic characteristics rather than a "one-size-fits-all approach."
authors.affiliation: Albert Einstein College of Medicine, Montefiore Clinical Diabetes Center, Bronx, NY 10461, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Zonszein
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15260, USA.
authors.forename: Manuel
authors.initials: M
authors.lastname: Lombardero
authors.affiliation: Case Western Reserve University and Cleveland VA Medical Center, Cleveland, OH 44106, USA.
authors.forename: Faramarz
authors.initials: F
authors.lastname: Ismail-Beigi
authors.affiliation: Mayo Clinic, Scottsdale, AZ 85259, USA.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Palumbo
authors.affiliation: Montreal Heart Institute, Hotel-Dieu CHUM (Centre Hospitalier de l'Université de Montréal), Montreal, QC, Canada H2W 1T8.
authors.forename: Suzy
authors.initials: S
authors.lastname: Foucher
authors.affiliation: Toronto General Hospital, Toronto, ON, Canada M5G 2C4.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Groenewoud
authors.affiliation: Lahey Clinic Medical Center, Burlington, MA 01805, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Cushing
authors.affiliation: University of Sao Paulo Heart Institute, 01246903 São Paulo, SP, Brazil.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Wajchenberg
authors.affiliation: Case Western Reserve University, Cleveland, OH 44106, USA.
authors.forename: Saul
authors.initials: S
authors.lastname: Genuth
authors.affiliation: University of Pittsburgh, Pittsburgh, PA 15260, USA.
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D003925:Diabetic Angiopathies / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D006949:Hyperlipidemias / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007333:Insulin Resistance; D008075:Lipoproteins, HDL / Q000097:blood*; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012307:Risk Factors; D045162:Thiazolidinediones / Q000627:therapeutic use; D014280:Triglycerides / Q000097:blood*
chemical_list: D015415:Biomarkers; D000960:Hypolipidemic Agents; D008075:Lipoproteins, HDL; D045162:Thiazolidinediones; D014280:Triglycerides; D008687:Metformin