Ciprofibrate effects on carbohydrate and lipid metabolism in type 2 diabetes mellitus subjects

Background and Aims: Atherosclerosis is the most common cause of morbidity and mortality in type 2 diabetes mellitus. Hyperglyceinia, dyslipoproteinem ia, arterial hypertension and coagulation abnormalities are the most import ant cardiovascular risk factors. Hypertriglyceridemia and low high density lipoprotein-cholesterol (HDLc) seem to be related with insulin resistance. Fibric acid derivates (fibrates) are effective in the treatment of dyslipop roteinemia in diabetes. Our aim was to evaluate the efficacy and safety of ciprofibrate in improving dyslipoproteinemia and its effect on fibrinogen p lasma concentrations, carbohydrate metabolism variations and insulin action . Methods and Results: 13 subjects with type 2 diabetes mellitus were treated with diet and placebo for 4 weeks and then randomized to one of two treatm ents: ciprofibrate 100 mg or placebo for four weeks. After a four-week wash -out period they were crossed over as shown in Figure 1. Total cholesterol, triglycerides, low density lipoprotein-cholesterol (LDLc), very low densit y lipoprotein-cholesterol (VLDLc), HDLc, Apolipoprotein B100, fibrinogen, i nsulin and Lp(a) were measured. Insulin erythrocytes union was made by the Gambhir method. There was a 15% decrease in total cholesterol (p<0.05) and 47% decrease in triglycerides (p<0.01); similar changes were observed in VL DL-cholesterol and VLDL-triglycerides; 17% increase in HDL-cholesterol (p<0 .05). No significant differences were observed in LDL-cholesterol, apolipop rotein B100 and lipoprotein (a). Fibrinogen decreased 10% (p<0.05). A non-s ignificant 10% decrease in insulin secretion (area under curve) after oral glucose was observed with ciprofibrate. These findings indicate a decrease in receptor affinity. A non-significant decrease in insulin receptor number /cells was also observed Conclusions: Ciprofibrate has a potent hypolipidemic effect, especially a d ecrease in triglycerides, VLDL and fibrinogen, and an increase in HDL-chole sterol, but does not influence glycemic control nor insulin action. Decreas ed insulin secretion may be due to peripheral rue of glucose due to the dru g's antilipolytic action. (C) 2000, Medikal Press.