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We read with interest the article by Izumino et al. (1), which suggests a therapeutic use of troglitazone, an insulin sensitizer, in Werner’s syndrome as well as in noninsulin-dependent diabetes mellitus (NIDDM). We here report another possible benefit of troglitazone treatment: prevention of atherosclerosis. We measured the intimal and medial complex thickness (IMT) of common carotid artery using B-mode ultrasound technique to evaluate early atherosclerotic lesions (2). First we investigated the relationship between IMT and urinary C-peptide levels (u-CPR) or insulin dosage in 106 Japanese subjects with NIDDM [52 males and 54 females, age 62.5 yr (se 0.9) yr]. Eighty-one of them were receiving insulin treatment, and the others were taking sulfonylureas. u-CPR of 24-hr urine samples were measured with a radioimmunoassay kit and were expressed as a mean value in three consecutive days. IMT values showed a positive correlation with both u-CPR (r = 0.655, P < 0.0001) and insulin dosage, calculated as an average dose per day (r = 0.399, P < 0.005). The correlation remained significant after adjusting for HbAIc, body mass index, age, serum total cholesterol, and triglyceride levels. Second, we examined the effect of short-term treatment with troglitazone (400 mg daily for 3 months) on IMT in 33 patients with NIDDM. Before troglitazone treatment they had been treated with sulfonylureas (32 glibenclamide and 1 gliclazide), which were continued in the same doses during the troglitazone treatment. Thirty-two diabetic subjects (29 receiving sulfonylureas and 3 diet alone) were examined as control group. The group given troglitazone showed a significant decrease in IMT after 3 months [IMT change: −0.196 mm (se 0.082) vs. control 0.034 mm (se 0.010), P < 0.01]. There was no relation between a decrease in IMT and a decline in HbAIc.

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