Triglyceride High-Density Lipoprotein Ratios Predict Glycemia-Lowering in Response to Insulin Sensitizing Drugs in Type 2 Diabetes: A Post Hoc Analysis of the BARI 2D

J Diabetes Res. 2015;2015:129891. doi: 10.1155/2015/129891. Epub 2015 May 27.

Abstract

Glycemic management is central in prevention of small vessel and cardiovascular complications in type 2 diabetes. With the plethora of newer medications and recommendations for a patient centered approach, more information is necessary to match the proper drug to each patient. We showed that BARI 2D, a five-year trial designed to compare two different glycemic treatment strategies, was suitable for assessing different responses according to different phenotypic characteristics. Treatment with insulin sensitizing medications such as thiazolidinediones and metformin was more effective in improving glycemic control, particularly in the more insulin resistant patient, when compared to the insulin provision strategy using insulin and or sulfonylureas. Triglyceride and high density lipoprotein ratio (TG/HDL-cholesterol ratio) was found to be a readily available and practical biomarker that helps to identify the insulin resistant patient. These results support the concept that not all medications for glycemic control work the same in all patients. Thus, tailored therapy can be done using phenotypic characteristics rather than a "one-size-fits-all approach."

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / blood
  • Cohort Studies
  • Coronary Artery Bypass
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / surgery
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / metabolism
  • Diabetic Angiopathies / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperglycemia / prevention & control*
  • Hyperlipidemias / complications
  • Hyperlipidemias / epidemiology
  • Hyperlipidemias / prevention & control*
  • Hypolipidemic Agents / therapeutic use*
  • Insulin Resistance*
  • Lipoproteins, HDL / blood*
  • Male
  • Metformin / therapeutic use
  • Middle Aged
  • Percutaneous Coronary Intervention
  • Risk Factors
  • Thiazolidinediones / therapeutic use
  • Triglycerides / blood*

Substances

  • Biomarkers
  • Hypolipidemic Agents
  • Lipoproteins, HDL
  • Thiazolidinediones
  • Triglycerides
  • Metformin