Prandial plus basal insulin lowers postprandial inflammatory markers
MedWire News: A prandial plus basal insulin regimen leads to lower postprandial increases in glucose and inflammatory markers than a basal insulin regimen, research shows.
The rise in postprandial glucose was strongly correlated with the rise in levels of inflammatory markers.
As reported in the journal Diabetic Medicine, Meng Tan (University of Michigan, Ann Arbor, USA) and team conducted a substudy of a clinical trial that examined the effects of 24 weeks of thrice-daily preprandial insulin lispro mix 50 (50% insulin lispro, 50% insulin lispro protamine suspension) or bedtime insulin glargine, both plus metformin, in Type 2 diabetes patients.
At 24 weeks, Tan and colleagues measured the changes in plasma high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) after a mixed-meal breakfast in 46 of the 96 original trial participants (prandial plus basal, n=25; basal group, n=21).
The researchers collected blood samples 5 minutes before the breakfast and at 1, 2, 3, 4, 6, and 8 hours afterwards.
They then compared them to the changes in insulin, postprandial glucose, and triglycerides.
The authors found that, compared with the basal insulin group, the prandial plus basal insulin group had significantly higher insulin (46,638 pmol/l vs 21,418 pmol/l), lower glucose (323.8 mmol/l vs 902.8 mmol/l), and lower triglycerides (23,962 mg/dl vs 25,975 mg/dl) after 24 weeks of treatment.
They also had lower hs-CRP (75,599 ng/ml vs 377,947 ng/ml), TNF-α (874.1 pg/ml vs 2150.1 pg/ml), and IL-6 (59.0 pg/ml vs 138.3 pg/ml).
The team also found that glucose levels were correlated with hs-CRP levels, TNF-α, IL-6 levels throughout the 8-hour postprandial period.
"The strong correlations between attenuation of the acute rise in post-meal glucose and inflammatory markers suggest that glucose may be a factor in their release," they explain.
In addition, insulin levels were inversely correlated with the three inflammatory biomarkers. However, after adjusting for glucose these inverse correlations were no longer significant.
"This suggests that the apparent correlation may be primarily related to glucose change," they say.
Triglyceride levels were not correlated with any of the biomarker levels.
"Cardiovascular outcome studies where post-meal hyperglycemia and meal-induced inflammation are reduced over a longer time period are needed to prove that these changes can decrease vascular disease in patients with Type 2 diabetes," concludes the team.
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By Sally Robertson