Rosiglitazone reduces insulin requirement and C-reactive protein levels in type 2 diabetic patients receiving peritoneal dialysis
Publication in refereed journal


摘要Background Glycemic control is important in determining the outcome of patients with diabetes on dialysis therapy. However, the choice of oral hypoglycemia agent is limited in these patients. Very often, a high dose of insulin is required because of the uremia-associated insulin-resistant state. Rosiglitazone (RSG), a thiazolidinedione, can improve insulin resistance, and its excretion does not rely on renal function. Moreover, it has an anti-inflammatory effect that might be beneficial in patients with renal failure. Methods: An open-label randomized study was performed in which 52 patients with type 2 diabetes on peritoneal dialysis therapy administered a constant dosage of subcutaneous insulin with stable glycemic control were randomly assigned to the administration of either RSG (fixed dose, 4 mg) plus insulin or insulin alone. Insulin was titrated to maintain hemoglobin A(1c) (HbA(1c)) and blood glucose at pretreatment levels. Study duration was 24 weeks. Results: Both groups had similar baseline demographic characteristics, HbA(1c) and glucose levels, insulin requirement, and C-reactive protein (CRIP) levels. Insulin requirement was decreased significantly in the RSG group (27.88 +/- 17.6 to 22.4 +/- 15.21 U/d; P < 0.001). There was a significantly greater decrease in insulin dosage in the RSG than control group (-21.5% versus +0.5%; P = 0.03), whereas glycemic control was similar between groups. At the end of the study, the RSG group also had significantly lower CRP levels than the control group (2.21 versus 8.59 mg/L; P = 0.03). No significant increase in such adverse effects as hypoglycemia, liver impairment, and fluid overload was observed in the RSG group. However, the RSG group was associated with more weight gain. Multivariate regression analysis (using decrease in HbA(1c) and lipid levels, change in insulin dosage, and treatment with RSG, with lipid-lowering agents) showed that only treatment with RSG was an independent predictor for posttreatment CRP level (P = 0.016). Conclusion: RSG in combination with insulin is well tolerated and beneficial in the treatment of patients with type 2 diabetes on peritoneal dialysis therapy by improving insulin sensitivity and decreasing inflammatory response.
著者Wong TYH, Szeto CC, Chow KM, Leung CB, Lam CWK, Li PKT
期刊名稱American Journal of Kidney Diseases
頁次713 - 719
關鍵詞diabetes; dialysis; inflammatory markers; insulin requirement; rosiglitazone
Web of Science 學科類別Urology & Nephrology; UROLOGY & NEPHROLOGY

上次更新時間 2020-08-08 於 00:40