الفهرس 
EpidemiologyOnly 14 pages are availabe for public view
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Abstract
Insulin resistance and Type 2 diabetes mellitus (T2DM) have
been recognized to be strongly linked years ago. Insulin resistance is
not only the most powerful predictor of future development of
T2DM; it is also a therapeutic target once hyperglycemia is present.
Most T2DM patients are treated with sulfonylureas but many of them
fail to achieve control on insulin resistance state and hyperglycemia
with sulfonylureas monotherapy. Therefore, they usually need either
to increase the dose, add some drugs increasing receptors sensitivity
to insulin or finally add insulin therapy.
Although several previous reports showed that L-carnitine
lowered blood glucose serum levels in T2DM patients, it remains
undetermined whether addition of L-carnitine to ongoing
sulfonylureas therapy is more effective than sulfonylureas
monotherapy for reducing insulin resistance and improving glycemic
state. This study aimed at investigating the efficacy of adding Lcarnitine
to ongoing glimepiride therapy compared to glimepiride
monotherapy in T2DM patients and to assess the effects of both
treatment modalities on blood glucose levels, glycated hemoglobin
(HbA1c), fasting insulin, extracellular part of insulin regulated
aminopeptidase (IRAPe) as a novel marker of insulin resistance,
tumor necrosis factor-alpha (TNF-α), visfatin and lipid profile.
Fifty eight eligible patients were recruited and prospectively
randomized to receive glimepiride 4 mg/day alone (group 1, n = 27),
or glimepiride 4 mg/day plus L-canitine 2 gm/day (group 2, n = 31)
for 6 months. Fasting blood sample was obtained before, 3 and 6
months after treatment for biochemical analysis of fasting and
Abstract
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postprandial blood glucose (FBG &PPBG), HbA1C, fasting insulin,
IRAPe, TNF-α, visfatin and lipid panel. Body mass index (BMI) and
homeostasis model assessment of insulin resistance (HOMA-IR
index) were also calculated. Systolic and diastolic blood pressures
(SBP & DBP) were also evaluated. Data were statistically analyzed
by unpaired Student’s t test and one way analysis of variance. P <
0.05 was considered statistically significant.
The obtained data showed that adding L-carnitine 1 gm twice
daily as adjuvant therapy to glimepiride has a significantly beneficial
effect on FBG, PPBG, HbA1C, fasting insulin, HOMA-IR index,
IRAPe, TNF-α, visfatin and whole lipid panel parameters but didn’t
show any beneficial effect on SBP, DBP and BMI.
It can be concluded that, adding L-carnitine 2 gm/day to
glimepiride 4 mg/day can be a better choice than increasing
glimepiride dose or addition of insulin therapy in improving insulin
sensitivity; glycemic control; and lipid profile in diabetic patients
who couldn’t achieve their therapeutic treatment goals with
glimepiride monotherapy.