Tip 2 diyabeti ve hipertansiyonu olan hastalarda telmisartan ve irbesartan tedavilerinin insülin direncine etkisi
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Date
2006
Authors
Taşlı, Babürşah
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Publisher
Uludağ Üniversitesi
Abstract
İnsülin direnci ve buna bağlı oluşan hiperinsülinemi, tip 2 diyabet ve hipertansiyon gelişmesinde önemli rol oynamakta, kardiyovasküler hastalıklarla ilişkili artmış risk faktörlerine yol açmaktadır. Bu risk faktörleri arasında dislipidemi, hemostazda değişme ve kronik inflamasyon bulunmaktadır. Hipertansiyon tedavisinde kullanılan Anjiyotensin II reseptör blokerlerinden telmisartan ve irbesartanın, Anjiyotensin II reseptör blokajı etkisinin yanında karbonhidrat ve lipid metabolizmasını düzenleyen, inflamasyonu baskılayan intrasellüler hormon reseptörü PPARγ’yı aktive edebildikleri gösterilmiştir. Bu ikili etki sayesinde telmisartan ve irbesartanın insülin direncinin sebep olduğu kardiyovasküler risklerin tedavisinde kullanılabileceği düşünülmektedir. Bu çalışmada, telmisartan ve irbesartanın tip 2 diyabeti ve hipertansiyonu olan hastalarda insülin direnci, inflamasyon, lipid ve karbonhidrat metabolizması üzerindeki etkilerinin karşılaştırılması amaçlanmıştır. Uludağ Üniversitesi Tıp Fakültesi İç Hastalıkları A.B.D. polikliniklerine başvuran tip 2 diyabeti ve hipertansiyonu olan 53 hasta çalışmaya alındı. Hastalar üç guruba ayrıldı. Birinci guruba (n=18) sadece diyet ve egzersiz tedavisi, 2. guruba (n=18) bu tedaviye ilaveten telmisartan, 3. guruba (n=17) irbesartan tedavisi uygulanarak 6 hafta izlendi. Çalışmanın sonunda bütün guruplarda BKİ, ortalama ağırlık, bel/kalça oranı, sistolik/diyastolik kan basıncı ve insülin direncinde tedavi öncesine göre anlamlı azalma saptandı. Telmisartan ve irbesartan gurubunda serum hs-CRP düzeyi tedavi öncesine göre anlamlı şekilde azaldı. Telmisartan gurubunda, tedavi öncesine göre HDL kolesterolde anlamlı şekilde artma, açlık kan şekeri, tokluk kan şekeri ve A1c de anlamlı şekilde azalma saptandı. Diyet-egzersiz yapan gurup ve irbesartan gurubunda tedavi sonunda, total kolesterol, TG, LDL kolesterol, HDL kolesterol, açlık kan şekeri, tokluk kan şekeri ve A1c de anlamlı olmayan değişiklikler izlendi. Sonuç olarak, telmisartan ve irbesartan tedavilerinin insülin direnci üzerine olan etkileri arasında bir fark olmadığı, insülin direncini azaltmada diyet ve egzersiz yapan kontrol gurubuna istatistiksel anlamda bir üstünlük sağlamadıkları görüldü.
Insulin resistance and hyperinsulinemia that occurs due to insulin resistance play an important role on the development of type 2 diabetes and hypertension while causing increased risk factors associated with cardiovascular diseases. Among these risk factors are dyslipidemia, change in hemostasis and chronic inflammation. It is shown that apart from their angiotensin II receptor blockage effect, angiotensin II receptor blockers telmisartan and irbesartan can activate intracellular hormone receptor PPARγ that regulates carbohydrate and lipid metabolism and suppresses inflammation. Owing to this dual effect, it is considered that telmisartan and irbesartan can be used for the treatment of insulin resistance and cardiovascular risks caused by it. The aim of this study was to compare the effects of telmisartan and irbesartan on insulin resistance, inflammation, lipid and carbohydrate metabolism of patients with type 2 diabetes and hypertension. 53 patients with type 2 diabetes and hypertension who were admitted to Uludağ University Faculty of Medicine Internal Diseases Department polyclinics were included in the study. Patients were separated into three groups. Only diet and exercise treatment were applied on the first group (n=18), in addition to this treatment, second group (n=18) was administered telmisartan and third group (n=17) was administered irbesartan and they were followed for 6 weeks. Significant decrease was detected in BMI, average weight, waist/hip ratio, systolic/diastolic blood pressure and insulin resistance in each group at the end of treatment. Serum hs-CRP level significantly decreased in telmisartan and irbesartan group in comparison to pre-treatment period. When compared to the pre-treatment period, significant increase in HDL Cholesterol and significant decrease in fasting blood glucose, postprandial blood glucose and A1c were detected in telmisartan group. Insignificant decreases were detected in total cholesterol, TG, LDL cholesterol, HD cholesterol, fasting blood glucose, postprandial blood glucose and A1c in diet-exercise applied control group and in irbesartan group. In conclusion, it was found that there was no difference between the effects of telmisartan and irbesartan treatments on insulin resistance and that they were not statistically superior to the exercise and control group in terms of decreasing insulin resistance.
Insulin resistance and hyperinsulinemia that occurs due to insulin resistance play an important role on the development of type 2 diabetes and hypertension while causing increased risk factors associated with cardiovascular diseases. Among these risk factors are dyslipidemia, change in hemostasis and chronic inflammation. It is shown that apart from their angiotensin II receptor blockage effect, angiotensin II receptor blockers telmisartan and irbesartan can activate intracellular hormone receptor PPARγ that regulates carbohydrate and lipid metabolism and suppresses inflammation. Owing to this dual effect, it is considered that telmisartan and irbesartan can be used for the treatment of insulin resistance and cardiovascular risks caused by it. The aim of this study was to compare the effects of telmisartan and irbesartan on insulin resistance, inflammation, lipid and carbohydrate metabolism of patients with type 2 diabetes and hypertension. 53 patients with type 2 diabetes and hypertension who were admitted to Uludağ University Faculty of Medicine Internal Diseases Department polyclinics were included in the study. Patients were separated into three groups. Only diet and exercise treatment were applied on the first group (n=18), in addition to this treatment, second group (n=18) was administered telmisartan and third group (n=17) was administered irbesartan and they were followed for 6 weeks. Significant decrease was detected in BMI, average weight, waist/hip ratio, systolic/diastolic blood pressure and insulin resistance in each group at the end of treatment. Serum hs-CRP level significantly decreased in telmisartan and irbesartan group in comparison to pre-treatment period. When compared to the pre-treatment period, significant increase in HDL Cholesterol and significant decrease in fasting blood glucose, postprandial blood glucose and A1c were detected in telmisartan group. Insignificant decreases were detected in total cholesterol, TG, LDL cholesterol, HD cholesterol, fasting blood glucose, postprandial blood glucose and A1c in diet-exercise applied control group and in irbesartan group. In conclusion, it was found that there was no difference between the effects of telmisartan and irbesartan treatments on insulin resistance and that they were not statistically superior to the exercise and control group in terms of decreasing insulin resistance.
Description
Keywords
İnsülin direnci, Tip 2 diyabet, Hipertansiyon, Telmisartan, İrbesartan, Insulin resistance, Type 2 diabetes, Hypertension, Telmisartan, Irbesartan
Citation
Taşlı, B. (2006). Tip 2 diyabeti ve hipertansiyonu olan hastalarda telmisartan ve irbesartan tedavilerinin insülin direncine etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.