caa a22 4500 475771435 CHVBK 20180406123618.0 cr unu---uuuuu 170329e20000901xx s 000 0 eng 10.1007/s001250051500 doi (NATIONALLICENCE)springer-10.1007/s001250051500 The influence of improved glycaemic control with insulin and sulphonylureas on acute phase and endothelial markers in Type II Diabetic subjects [Elektronische Daten] [J. S. Yudkin, A. Panahloo, C. Stehouwer, J. J. Emeis, K. Bulmer, V. Mohamed-Ali, A. E. Denver] Aims/hypothesis. Improved glycaemic control might reduce both microvascular and macrovascular complications of Type II diabetes (non-insulin-dependent) mellitus. To explore such possible mechanisms, we investigated the effects of intensive treatment on markers of endothelial dysfunction and of acute phase activation, using both sulphonylureas and insulin. Methods. In a randomised cross-over study we gave sulphonylureas or insulin each for a period of 16 weeks to 22 poorly controlled Type II diabetic subjects who were being treated by diet. There was a 4 week washout period between each treatment. Subjects were studied at baseline and at the end of each treatment. Results. Treatment with sulphonylureas and insulin resulted in similar improvements in glycaemic control (glycated haemoglobin, baseline: 11.8 [(SD 2.2)%; after sulphonylureas: 8.6 (1.2)%, p < 0.001; after insulin: 8.6 (1.2)%, p < 0.001] and in insulin sensitivity {metabolic clearance rate of glucose, baseline: median 1.75 [interquartile (IQ) range 1.41, 2.27] ml · kg-1· min-1; after sulphonylureas: 2.41 (1.82, 3.01) ml · kg-1· min-1, p = 0.001; after insulin: 2.23 (1.92, 2.75) ml · kg-1· min-1, p = 0.027}. There were no significant changes in concentrations of endothelial markers von Willebrand factor, cellular fibronectin, thrombomodulin, tissue plasminogen activator, soluble E-selectin or soluble intercellular adhesion molecule-1 or in urinary albumin excretion rate after either treatment period. Concentrations of C-reactive protein were not significantly influenced by sulphonylureas but fell after insulin [baseline: median 4.50 (IQ range 1.37, 6.44) μg · ml-1; sulphonylureas: 2.69 (0.88, 9.65) μg · ml-1 (p = 0.53); insulin: 2.07 (1.16, 5.24) μg · ml-1 (p = 0.017)]. There were, however, no significant effects of either treatment on circulating concentrations of fibrinogen (p = 0.28-0.34) or of the proinflammatory cytokines interleukin-6 or tumour necrosis factor-α (p = 0.65-0.79). Conclusion/interpretation. Markers of endothelial dysfunction and concentrations of proinflammatory cytokines in Type II diabetes are not influenced by improved glycaemic control over 16 weeks. Improved metabolic control with insulin could, however, be associated with reduced concentrations of the acute phase marker C-reactive protein. [Diabetologia (2000) 43: 1099-1106] Springer-Verlag Berlin Heidelberg, 2000 Keywords Glycaemic control nationallicence insulin nationallicence sulphonylureas nationallicence insulin resistance nationallicence endothelial dysfunction nationallicence tumour necrosis factor-α nationallicence interleukin-6 nationallicence C-reactive protein nationallicence Yudkin J. S. Department of Medicine, University College London Medical School, Whittington Hospital, London, UK, GB aut Panahloo A. Department of Medicine, University College London Medical School, Whittington Hospital, London, UK, GB aut Stehouwer C. Department of Medicine, Academic Hospital Vrije University Amsterdam, Netherlands, NL aut Emeis J. J. Gaubius Laboratory, Netherlands Organisation for Applied Scientific Research-Prevention and Health (TNO-PG), Leiden, Netherlands, NL aut Bulmer K. Department of Medicine, University College London Medical School, Whittington Hospital, London, UK, GB aut Mohamed-Ali V. Department of Medicine, University College London Medical School, Whittington Hospital, London, UK, GB aut Denver A. E. Department of Medicine, University College London Medical School, Whittington Hospital, London, UK, GB aut https://doi.org/10.1007/s001250051500 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s001250051500 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Yudkin J. S. Department of Medicine, University College London Medical School, Whittington Hospital, London, UK, GB aut NATIONALLICENCE 700 1- Panahloo A. Department of Medicine, University College London Medical School, Whittington Hospital, London, UK, GB aut NATIONALLICENCE 700 1- Stehouwer C. Department of Medicine, Academic Hospital Vrije University Amsterdam, Netherlands, NL aut NATIONALLICENCE 700 1- Emeis J. J. Gaubius Laboratory, Netherlands Organisation for Applied Scientific Research-Prevention and Health (TNO-PG), Leiden, Netherlands, NL aut NATIONALLICENCE 700 1- Bulmer K. Department of Medicine, University College London Medical School, Whittington Hospital, London, UK, GB aut NATIONALLICENCE 700 1- Mohamed-Ali V. Department of Medicine, University College London Medical School, Whittington Hospital, London, UK, GB aut NATIONALLICENCE 700 1- Denver A. E. Department of Medicine, University College London Medical School, Whittington Hospital, London, UK, GB aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer