Treatment with rosiglitazone has a more favorable impact on arterial stiffness than metformin in people with Type 2 diabetes, a small clinical study suggests.

The research was undertaken by Turkish researchers with the aim of evaluating the long-term impact of two insulin-sensitizing drugs ??” rosiglitazone, a thiazolidinedione, and metformin, a biguanide ??” on markers of diabetic vasculopathy.

In all, 50 drug-naïve patients with Type 2 diabetes were randomly assigned to receive rosiglitazone 4 mg/day, metformin 850 mg/day, or no drug therapy. All groups received standard advice on diet and physical activity.

The study lasted 52 weeks. Compared with baseline, patients in the rosiglitazone group showed a significant improvement in small-artery elasticity index, a measure of arterial stiffness. This parameter was unchanged in the other two groups.

Serum levels of matrix metalloproteinase-9 ??” a marker of inflammation ??” fell by 13.5% in the metformin group and by 27.2% in the rosiglitazone group, and both of these changes were significant versus baseline.

Serum levels of another inflammatory marker, monocyte chemoattractant protein-1, were unchanged in all three groups over the study period, however.

Commenting on their study, Sinem Kiyici (Uludag University, Bursa, Turkey) and co-authors say that rosiglitazone therapy had a favorable effect on vascular stiffness and inflammation whereas metformin impacted only inflammation. Interestingly, these effects appeared to be independent of glycemic control.

Writing in the journal Diabetes Research and Clinical Practice, the team concludes: “Since atherosclerotic vascular disease is the major cause of mortality and morbidity in patients with Type 2 diabetes mellitus… the effect of antidiabetic agents on arterial stiffness may be suggested when selecting therapy.”

However they add: “The clinical relevance of these data should be validated by additional prospective studies.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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Diabetic patients with more severe periodontal disease are at increased risk for neuropathic foot ulceration, say researchers.

“Diabetic neuropathy (DN) has been associated with oral dryness, tooth loss and an increased risk for foot ulceration, but the association between periodontal problems and DN has not been fully elucidated,” explain Helena Schmid (Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil) and team.

Writing in the journal Diabetes Research and Clinical Practice, the authors report that of 122 patients with Type 2 diabetes, none/mild and moderate/severe periodontal disease was observed in 40.2% and 32.0% individuals, respectively, and a further 27.8% of the group were edentulous.

The patients had a mean age of 60.5 years, duration of diabetes of 14.5 years, and glycated hemoglobin of 9.3%.

Degree of severity of periodontal disease correlated significantly with presence of neuropathic foot ulceration. Overall, 18.4%, 68.2%, and 61.8% of the participants who had none/mild or moderate/severe periodontal disease, or who were completely edentulous, respectively, had neuropathic foot ulceration.

Following adjustment for gender, age, diabetes duration, dental healthcare, and education, the researchers found that moderate/severe periodontal disease and edentulism increased the risk for neuropathic foot ulceration 6.6 and 4.9 fold, respectively, compared with none/mild periodontal disease.

Schmid and colleagues caution that “it is still unclear whether severe neuropathy or other simultaneous complications increase the chances of periodontal disease.”

They suggest: “Future prospective studies should be conducted to evaluate potential mechanisms of diabetic complications, such as systemic and inflammatory factors, neuropathy measurements, occurrence of ulcers and diabetes-associated periodontitis.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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