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인슐린 저항성이 있는 제 2형 당뇨병 환자에서 Rosiglitazone의 치료 효과 및 반응도 예측인자의 분석

Other Titles
 Therapeutic efficacy and factors that affect response of rosiglitazone in insulin-resistant type 2 diabetes 
 김유미  ;  김대중  ;  허갑범  ;  이현철  ;  임승길  ;  송영득  ;  차봉수  ;  안철우  ;  최성희  ;  정혜원  ;  이광은  ;  김혜진  ;  강은석 
 Korean Journal of Medicine (대한내과학회지), Vol.64(1) : 60-69, 2003 
Journal Title
 Korean Journal of Medicine (대한내과학회지) 
Issue Date
Rosiglitazone ; Insulin resistance ; Type 2 diabetes mellitus
Rosiglitazone ; Insulin resistance ; Type 2 diabetes mellitus
Background: Rosiglitazone, an insulin sensitizer of thiazolidinedione class, is known as a highly selective and potent agonist for the peroxisome proliferator-activated receptor-γ. This study was performed to evaluate the antidiabetic activity and insulin sensitizing effect of rosiglitazone combination therapy in insulin-resistant type 2 diabetic patients who were poorly controlled with oral agents such as metformin and/or sulfonylurea. The factors affecting response of rosiglitazone were also evaluated on the basis of the degree of glycemic control. Methods: One hundred twenty insulin-resistant (glucose disposal rate, Kitt < 2.5%/min) type 2 diabetic patients (M:F=42:78, mean age 58.6±9.2 years, body mass index 24.2±2.8 ㎏/㎡) were enrolled and randomly divided into two groups. For 12 weeks, the treated group daily received 4 ㎎ of rosiglitazone and the control group had diet and exercise therapy in addition to previous medications. The responders were defined as more than 20% decrease of fasting plasma glucose level or more than 1% decrease of HbA1c. As for the indices of insulin resistance and insulin secretory function, Kitt (Kitt=0.693/t1/2 × 100) by insulin tolerance test, HOMAIR and HOMAβ-cell function by ‘HOMA index (Homeostasis model assessment)’ were evaluated. Results: In rosiglitazone treated group (60 patients, M:F=19:45), 12 weeks of rosiglitazone treatment decreased fasting plasma glucose (28.2%), postprandial 2-hour glucose (23.2%), and HbA1c (12.2%). Rosiglitazone also significantly decreased HOMAIR (41.2%), and increased Kitt (53.3%) and HOMAβ-cell function (46.9%). Forty-five patients (75%) satisfied responder. Females and those who had higher body mass index and waist-hip ratio showed better response. The basal fasting plasma glucose, HbA1c, and systolic blood pressure were also higher in responders. The responders showed significantly higher fasting serum insulin level and HOMAIR, and also higher tendency of fasting serum C-peptide level and HOMAβ-cell function than nonresponders. Conclusion: From these results, rosiglitazone treatment can improve not only hyperglycemia and insulin resistance but also insulin secretory function in uncontrolled insulin-resistant type 2 diabetes. The factors that affect response of rosiglitazone are female, obesity (especially central obesity), high insulin secretory function, and severe insulin resistance. As a conclusion, the therapeutic efficacy or response of rosiglitazone is likely to depend on the degree of preserved pancreatic β-cell function and the severity of insulin resistance.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Eun Seok(강은석) ORCID logo https://orcid.org/0000-0002-0364-4675
Ahn, Chul Woo(안철우) ORCID logo https://orcid.org/0000-0003-3733-7486
Lee, Hyun Chul(이현철)
Lim, Sung Kil(임승길)
Cha, Bong Soo(차봉수) ORCID logo https://orcid.org/0000-0003-0542-2854
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