title: Cooling down inflammation in type 2 diabetes: how strong is the evidence for cardiometabolic benefit?
abstract: Chronic inflammation is supposed to be an important mediator of cardiometabolic dysfunctions seen in type 2 diabetes. In this mini-review, we collected evidence (PubMed) from randomized controlled trials (through March 2016) evaluating the effect of anti-inflammatory drugs on indices of glycemic control and/or cardiovascular events in people with type 2 diabetes. Within the last 25 years, many anti-inflammatory drugs have been tested in type 2 diabetes, including hydroxychloroquine, anti-tumor necrosis factor therapies (etanercept and infliximab), salsalate, interleukin-1 antagonists (anakinra, canakinumab, gevokizumab, LY2189102), and CC-R2 antagonists. Despite being promising, the observed effects on HbA1c or glucose control remain rather modest in most clinical trials, especially with the new drugs. There are many trials underway with anti-inflammatory agents to see whether patients with cardiovascular diseases and/or type 2 diabetes may have clinical benefit from marked reductions in circulating inflammatory markers. Until now, a large trial with losmapimod (a p38 inhibitor) among patients with acute myocardial infarction, including one/third of diabetic patients, showed no reduction in the risk of major ischemic cardiovascular events. Further evidence is warranted in support of the concept that targeting inflammation pathways may ameliorate glycemic control and also reduce cardiovascular complications in type 2 diabetes.
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Endocrinology and Metabolic Diseases Unit, Second University of Naples, Piazza L. Miraglia n° 2, 80138, Naples, Italy. mariaida.maiorino@unina2.it.
authors.forename: Maria Ida
authors.initials: MI
authors.lastname: Maiorino
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Endocrinology and Metabolic Diseases Unit, Second University of Naples, Piazza L. Miraglia n° 2, 80138, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bellastella
authors.affiliation: Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Endocrinology and Metabolic Diseases Unit, Second University of Naples, Piazza L. Miraglia n° 2, 80138, Naples, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Giugliano
authors.affiliation: Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
authors.forename: Katherine
authors.initials: K
authors.lastname: Esposito
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001786:Blood Glucose; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D019468:Disease Management; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007249:Inflammation / Q000150:complications* / Q000188:drug therapy
chemical_list: D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: Anti-inflammatory drugs; Cardiovascular complications; Glycemic control; Inflammation; Type 2 diabetes