Effect of pioglitazone on lipids in well controlled patients with diabetes mellitus type 2 -- results of a pilot study.

INTRODUCTION: Patients with diabetes mellitus type 2 are characterized by a typical dyslipoproteinemia. Improvement in glucose control usually also ameliorates this dyslipoproteinemia. It is unclear whether different antidiabetic strategies differ in their effects on the lipid profile. Particularly, it is unknown whether glitazones improve lipid values independently of their effects on glucose metabolism. METHODS: Ten patients well controlled on sulfonylureas (HbA1c 6.9 +/- 0.5 %) with diabetic dyslipoproteinemia were treated with additional pioglitazone (30 mg/d) for 3 months. Every 4 weeks the sulfonylurea dose was adjusted to keep HbA1c and fasting glucose constant. Before and after 3 months of pioglitazone therapy lipid metabolism was determined in detail (cholesterol, triglyceride, LDL-cholesterol, HDL-cholesterol, VLDL-cholesterol, VLDL-triglycerides, lipoprotein(a), LDL-subtype distribution by isopycnic density gradient ultracentrifugation). RESULTS: Although glucose control remained unchanged (HbA1c 6.9 +/- 0.5 % vs. 6.8 +/- 0.6 %; fasting glucose concentration 7.7 +/- 1.1 vs. 7.3 +/- 1.3 mmol/l) we observed a significant reduction in triglyceride concentration (1.9 +/- 0.6 vs. 1.4 +/- 0.5 mmol/l, - 26 %, p < 0.01), a significant increase in HDL-cholesterol concentration (1.2 +/- 0.2 vs. 1.4 +/- 0.2 mmol/l, + 14 %, p < 0.05), a significant decrease in LDL/HDL-ratio (3.03 +/- 0.77 vs. 2.51 +/- 0.61, - 24 %, p < 0.05) and non-significant improvements in total cholesterol, LDL-cholesterol, VLDL-triglycerides, and VLDL-cholesterol concentrations. The LDL-subtype profile improved (significant reduction [- 20 %] in small dense LDL). CONCLUSIONS: This pilot study indicates that at comparable fasting glucose concentration and at comparable HbA1c value pioglitazone is superior to sulfonylureas concerning the improvement of diabetic dyslipoproteinemia. Whether this relates to indirect effects (improvement in insulin sensitivity) or direct effects (stimulation of PPARalpha) remains to be determined.

Dissection of resistance to soil-borne yellow-mosaic-inducing viruses of barley (BaMMV, BaYMV, BaYMV-2) in a complex breeders' cross by means of SSRs and simultaneous mapping of BaYMV/BaYMV-2 resistance of var. 'Chikurin Ibaraki 1'.

Ninety-three F(1)-derived doubled haploid (DH) lines from a complex breeders' cross involving the Japanese genotype 'Chikurin Ibaraki 1', which is resistant to barley mild mosaic virus (BaMMV) and two strains of barley yellow mosaic virus (BaYMV and BaYMV-2), three susceptible varieties ('Hamu', 'Julia' and a breeding line) and cv. 'Carola', which carries rym4 conferring resistance to BaMMV and BaYMV, were analysed for resistance to BaMMV, BaYMV and BaYMV-2. The DH lines fell into four phenotypic classes. In addition to completely resistant and susceptible genotypes, DHs were observed which were either resistant to BaMMV and BaYMV or to BaYMV and BaYMV-2. For BaMMV and BaYMV-2 resistance, segregation ratios approaching 1r:1s were observed, suggesting the presence of single resistance genes. In contrast, the segregation ratio for BaYMV fits a 3r:1s segregation ratio, suggesting the presence of two independently inherited genes. From the genetic analysis, we conclude that a resistance locus effective against BaYMV and BaYMV-2 originates from Chikurin Ibaraki 1 and segregates independently from the Carola-derived rym4 resistance that is effective against BaYMV and BaMMV. The BaMMV resistance in Chikurin Ibaraki 1 has probably been lost during population development. This hypothesis was tested using a simple-sequence repeat (SSR) marker (Bmac29) linked to rym4. All BaMMV-resistant DH lines supported amplification of the rym4-resistance diagnostic allele. To identify the genetic location of the Chikurin Ibaraki 1-derived resistance against BaYMV/BaYMV-2, bulked DNA samples were constructed from the four resistance classes, and bulked segregant analysis was performed using a genome-wide collection of SSRs. Differentiating alleles were observed at two linked SSRs on chromosome 5H. The location of this BaYMV/BaYMV-2 resistance locus was confirmed and further resolved by linkage analysis on the whole population using a total of five linked SSRs.

[Effect of glucose control on lipid levels in patients with type 2 diabetes]. / Einfluss einer verbesserten Blutzuckereinstellung auf den Lipidspiegel bei Patienten mit Typ-2-Diabetes.

BACKGROUND AND OBJECTIVE: The dyslipoproteinemia characterizing patients with type 2 diabetes is a major risk factor for atherosclerosis. Prospective studies indicate that an improved glucose control is associated with lower lipid levels. In this study we evaluated whether an improvement of the lipid status can also be observed in a routine clinical setting. Furthermore, we evaluated how many patients achieve lipid target levels by improving glucose control. METHODS: In 51 type 2 diabetics (60 +/- 12 ys., 29 men, 22 women) lipid values were determined before and after improvement of glucose metabolism (6 - 12 weeks, HbA1c 7.9 +/- 1.9 % vs. 7.1 +/- 1.3 %). Patients on lipid-lowering medication or with atherosclerosis were excluded. The improved glucose control was achieved by starting/intensifying treatment with diet (n = 5), acarbose (n = 5), metformin (n = 10), sulfonylurea/glinide (n = 12) or insulin (n = 19). RESULTS: The decrease in HbA1c was associated with a decrease in total cholesterol (232 +/- 64 vs. 216 +/- 35 mg/dl, p < 0.05) and triglycerides (348 +/- 448 vs. 216 +/- 139 mg/dl, p < 0.01), while HDL- and LDL-cholesterol did not change significantly. Only in patients with triglycerides > 200 mg/dl did changes in HbA1c-levels correlate with changes in triglyceride-levels (r(2) = 0.32, p = 0.012). Lipid target levels were reached in seven of 51 patients (five of 51 patients before improvement of HbA1c). CONCLUSION: Although in routine clinical practice an improvement in HbA1c results in better lipid values. This improvement is small and is usually not sufficient to reach lipid target levels.

Lack of an association of urinary albumin excretion with interleukin-6 or C-reactive protein in patients with type 2 diabetes.

The reason for the elevation of fibrinogen concentration in diabetic patients with nephropathy is not known so far. In order to elucidate the mechanism of such an increase in fibrinogen levels, we investigated haemorheological and inflammatory markers in type 2 diabetic patients in a cross-sectional design. Thirty-two non-smoking type 2 diabetic patients (13 women, 19 men; body mass index 29.1+/-5.4 kg/m2, age 62.8+/-12.1 years) were investigated. Patients with C-reactive protein levels >1.5 mg/dl were excluded from the study. Concentration of fibrinogen was measured by immunonephelometry, C-reactive protein by immunoturbidimetry, and interleukin-6 (IL-6) by an enzyme-linked immunosorbent assay, and viscosity of plasma and of whole blood was determined by rotation viscosimetry. Concentrations of inflammatory parameters were well correlated with each other (p<0.05 for all correlations): IL-6 with C-reactive protein (r=0.48), and C-reactive protein with fibrinogen (r=0.41). While no associations were found with concentrations of C-reactive protein or IL-6, urinary albumin excretion was correlated with erythrocyte sedimentation rate (r=0.47) and with fibrinogen concentration (r=0.39; p<0.05). In patients with type 2 diabetes mellitus, urinary albumin excretion was not associated with concentrations of IL-6 or C-reactive protein. These results suggest an IL-6-independent mechanism for increased fibrinogen levels and erythrocyte sedimentation rate in type 2 diabetic patients with increased urinary albumin excretion.

The prevention education program (PEP). A prospective study of the efficacy of family-oriented life style modification in the reduction of cardiovascular risk and disease: design and baseline data.

We describe design and baseline data of the Prevention Education Program (PEP), a home-based and family-oriented intervention program, aimed to assess and improve cardiovascular risk factors in school children and their families during an intervention period of 10 years. Started in 1994 in the German town of Nuremberg, currently 37 elementary schools (22 control and 15 intervention schools) are enrolled including 1740 families (1740 first graders, 3046 parents, and 1521 siblings). Major cardiovascular risk factors as well as dietary behavior are evaluated yearly using structured interview, physical examination, laboratory analysis, and seven-day-dietary protocols. The intervention package is applied to all families from intervention schools using regular home visits, health curricula and group sessions. Primary outcome is any reduction in cardiovascular risk factors by dietary intervention and health education compared to the control group getting only written information on the individual risk profile. The presented baseline data showing a high prevalence of cardiovascular risk factors in adults and in their children underline the need for such an intervention program in Germany.