Gemfibrozil improves insulin sensitivity and flow-mediated vasodilatation in type 2 diabetic patients

Background Endothelial dysfunction is an early feature of atherosclerosis. The relationship between insulin action and hypertriglyceridaemia on endoth elial function is still debated. Materials and Methods This study was designed to determine the effect of a 3 month treatment with Gemfibrozil (GF) on flow-mediated vasodilatation and insulin sensitivity. Ten type 2 diabetic patients were randomised in cross over, double blind fashion, either to GF, 600 mg b.i.d. or placebo, for 12 weeks. Lipid profile, low-density lipoprotein (LDL) distribution and flotat ion properties, insulin action and flow-mediated vasodilatation (FMD) by br achial artery ultrasound, were assessed. Results GF decreased serum triglyceride (TG) concentration with an absolute difference of 1.79 +/- 1.28 mmol L-1 (P < 0.0016) between active treatment and placebo, and significantly increased serum high-density lipoprotein (H IDL) cholesterol (P = 0.0233). No differences were observed in total, inter mediate-density lipoproteins (IDL), LDL cholesterol concentration and LDL p eak buoyancy between treatments. GF also improved SI, an index of insulin a ction (P = 0.005). The FMD was 7 +/- 3% in the baseline condition, 7 +/- 2% during placebo and 14 +/- 3% after GF (P < 0.006). Conclusions GF treatment improves both insulin action and flow-mediated vas odilatation in type 2 diabetic patients. The reduction of TG concentration allows the simultaneous correction of two important components of the metab olic syndrome.