COMPLEMENTARY INSULIN THERAPY IMPROVES BLOOD-GLUCOSE AND SERUM-LIPID PARAMETERS IN TYPE-2 (NON-INSULIN-DEPENDENT) DIABETIC-PATIENTS .2. EFFECTS ON SERUM-LIPIDS, LIPOPROTEINS AND APOPROTEINS

The aim of the present study was to evaluate the effects of complement ary insulin therapy, consisting of a single dose of 1 to 8 units of sh ortacting insulin before each meal (4-6x daily) and sometimes at 02.30 h, on concentrations of serum lipids, lipoproteins and apoproteins in type 2 (non-insulin-dependent) diabetic patients, unsatisfactorily co ntrolled either by oral hypoglycemic agents (OHA) or by longacting ins ulin 1-2x daily (INS 1-2). Compared means +/-SD. Patients on INS 1-2 ( n=82) had better baseline glycemic control than patients on OHA (n=68) (HbAlc: 9.33+/-1.76% vs. 10.59+/-1.83%, p<0.001 and fructosamine: 3.3 4+/-0.74 mmol/l vs. 3.85+/-0.84 mmol/l, p<0.001) and serum triglycerid e concentrations (3.03+/-2.05 mmol/l vs. 4.95+/-4.48 mmol/l, p<0.001), in spite of longer duration of diabetes (13.35+/-8.07 years vs. 10.1/-6.9 years, p<0.001). After 8-10 weeks of complementary insulin thera py, OHA patients (n=33) improved both the glycemic control (HbAlc: 10. 5+/-1.78% vs. 9.0+/-1.75%, p<0.001 and fructosamine: 4.0+/-0.85 mmol/l vs. 3.5+/-0.76 mmol/l, p<0.001) and most of the lipid parameters (dec reased serum triglyceride: 5.8+/-5.64 mmol/l vs. 3.6+/-4.69 mmol/l, p< 0.001, total cholesterol/HDL-cholesterol: 6.8+/-3.13 vs. 5.6+/-2.23, p <0.01 and increased HDL-cholesterol: 1.0+/-0.30 mmol/l vs. 1.2+/-0.30 mmol/l, p<0.001, apo AI: 1.6+/-0.26 g/l vs. 1.8+/-0.28 g/l, p<0.001, L pAI particles: 0.6+/-0.1 g/l vs. 0.7+/-0.12 g/l, p<0.001 and LDL-chole sterol/apo B: 2.1+/-0.67 vs. 2.7+/-0.67, p<0.001). In patients previou sly on INS 1-2x (n=34), complementary insulin therapy with reduced dos e of insulin per day (49.6+/-22.5 U/d vs. 36.6+/-13.3 U/d, p<0.001) di d not further improve glycemic control but improved the number of proa therogenic and antiatherogenic lipoprotein particles (decreased apo B: 1.7+/-0.52 g/l vs. 1.5+/-0.94 g/l, p<0.01, apo AI/Lp AI: 2.9+/-1.01 v s. 2.3+/-0.98, p<0.01 and increased Lp AI particles: 0.6+/-0.10 g/l vs ; 0.7+/-0.12 g/l, p<0.0001); BMI also decreased (29.4+/-4.28 kg/m(2) v s. 28.9+/-4.24 kg/m(2), p<0.05). These results demonstrate that comple mentary insulin therapy probably induces antiatherogenic lipoprotein c hanges in NIDDM patients previously treated by either OHA or INS 1-2x. Thus, this type of therapy should be used more often and start earlie r, and should be preferred to longacting insulins.