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Troglitazone and Small Low-Density Lipoprotein in Type 2 Diabetes
- Tsutomu Hirano, MD;
- Gen Yoshino, MD; and
- Tsutomu Kazumi, MD
- Showa University School of Medicine; Tokyo, Japan Toho University School of Medicine; Tokyo, Japan Ilyogo Rehabilitation Center Hospital; Tokyo, Japan
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TO THE EDITOR:
Several recent studies suggest the association of a preponderance of small, dense low-density lipoprotein (LDL) particles, potent atherogenic lipoproteins, with insulin resistance [1, 2]. However, it is still unknown whether insulin resistance or other factors related to insulin resistance directly regulate LDL size. We evaluated the direct association between insulin resistance and LDL size by treating patients with troglitazone, a new oral hypoglycemic agent [3] that ameliorates insulin resistance in patients with type 2 diabetes mellitus [4].
Thirty patients who had type 2 diabetes treated with sulfonylurea were enrolled in this study. The levels of fasting plasma glucose, hemoglobin A1c, and insulin were significantly suppressed by treatment with troglitazone (400 mg/d) for 3 months (Table 1). The average LDL-particle diameter, measured by 2% to 16% gradient polyacrylamide gel electrophoresis [5], was remarkably enlarged (Table 1). Thus, the number of patients with LDL pattern B (diameter ≤ 25.5 nm) was dramatically reduced from 13 to 1. Although plasma triglyceride levels were not changed significantly, an excellent correlation between increase in LDL size and decrease in plasma triglyceride levels was seen (r = −0.508; P < 0.001) during treatment. No correlations were found between changes in LDL size and plasma glucose, hemoglobin A1c, or insulin levels. Because the hypoglycemic action of troglitazone is completely attributed to decrease in insulin resistance [3, 4], our preliminary study suggests that LDL size is more directly influenced by triglyceride. metabolism than by improvement of insulin sensitivity itself. Troglitazone may have favorable effects on the prevention of coronary heart disease in patients with type 2 diabetes, in part through the reduction of small LDL particles.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
