The Effect of Telmisartan and Metformin on Insulin Resistance in Metabolic Syndrome Patients with Insulin Therapy

Siswi Oktariani; Raden Bowo Pramono; Hemi Sinorita

doi:10.22146/acta interna.5731

The Effect of Telmisartan and Metformin on Insulin Resistance in Metabolic Syndrome Patients with Insulin Therapy

https://doi.org/10.22146/acta%20interna.5731

Siswi Oktariani^(1*), Raden Bowo Pramono⁽²⁾, Hemi Sinorita⁽³⁾

(1)
(2)
(3)
(*) Corresponding Author

Abstract

ABSTRACT
Background: Recommendations for therapy insulin resistance are metformin and thiazolidindion. Side effects of thiazolidindion due to peripheral edema occurs to 2-5% and increased 5-15% when combined with insulin therapy. Telmisartan, an angiotensin receptor blocker, has anti-hypertensive effects and improve insulin resistance. Telmisartan effect on peroxisome proliferator activated receptor γ agonist and has the same structure of the group thiazolidindion, pioglitazone. The research objective was to determine the effects of telmisartan and metformin on insulin resistance in metabolic syndrome patients with insulin therapy.
Methods: This study used a before-after design. The study was conducted in the internal medicine clinic of the endocrinology department of Dr. Sardjito Hospital Yogyakarta. Subjects were patients who met the diagnosis of metabolic syndrome based on the IDF 2005, hypertension and receive insulin therapy. Subjects given metformin and telmisartan therapy for 12 weeks. Subjects examined HOMA IR before and after treatment. The average decrease in HOMA IR was tested by paired t test or Wilcoxon test. P value <0.05 was considered signifi cant.
Result: The total sample were 27 subjects. Data analysis was performed on 11 subjects. Fasting blood glucose before and after treatment was signifi cantly decreased (p<0.001) whereas the fasting insulin levels increased. HOMA IR was signifi cantly decreased after treatment {p = 0.004 (5.79 – 20.26), CI 95%}.
Conclusion: this study found insulin resistance decreased signifi cantly in patients with the metabolic syndrome of insulin therapy who received metformin and telmisartan.
Keywords : metabolic syndrome, insulin therapy, metformin, telmisartan, HOMA IR

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References

REFERENCES

Bahadir, O., Uzunzulu, M., Oguz, A., Bahadir, M.,A. 2007. Effects of Telmisartan and Losartan on Insulin Resistance in Hypertensive Patients with Metabolic Syndrome. Hypertens Res.; 30: 49–53

IDF, 2006, The Metabolic Syndrome, International Diabetes Federation

Kurtz, T.W., 2006, New Treatment Strategies for Patients with Hypertension and Insulin Resistance, The American Journal of Medicine, Vol 119 (5A): 24S-305

S ch e e n , A , J. , 2 0 0 4 C o m b i n e d hiazolidinedione-insulin therapy: should we be concerned about safety? Drug saf., 27(12) : 841-856

Singh, B., Saxena, A., 2010,Surrogate markers of insulin resistance: A review, World J Diabetes, 1(2): 36-47

Esteghamati, A., Ashraf, H., Khalilzadeh, O., Zandieh, A., Nakhjavani, Z. M., Rashidi, A., et al., 2010, Optimal cutoff of homeostasis model assessment of insulin resistance (HOMA IR) for the diagnosis of metabolic syndrome: third national surveillance of risk factors of noncommunicable diseases in Iran. Nutrition & Metabolism, 7:26

Qu, H.Q., Li, Q., Rentfro, A.R., Fisher-Hoch, S.P., McCormick, J.B., 2011, The Definition of Insulin Resistance Using HOMA IR for Americans of Mexican Descent Using Machine Learning,PLoS ONE, www.plosone.org

Cornier, M., Dabelea, D., Hernandez, T.L., Lindstrom, R.C., Steig, C. J., Stob, N. R., et al. 2008. The Metabolic Syndrome. Endocrine Reviews; 29(7): 777–822

Bailei, C.,J.,Turner, R.,C. 1996. Metformin. The New England Medical Journal ; 334 : 574-579

Schupp, M., Janke, J., Clasen, R., Unger, T., Kintscher, U., 2004,. Angiotensin Type 1 Receptor Blockers Induce Peroxisome Proliferator–Activated Receptor- γ Activity, Circulation, 109: 2054-2057

Shiota, A., Shimabukuro, M., Fukuda, D., Soeki, T., et al., 2012, Telmisartan ameliorates insulin sensitivity by activating the AMPK/SIRT1 pathway in skeletal muscle of obese db/db mice, Cardiovascular Diabetology, 11:139

Yki-Jarvinen, H., 2004, Thiazolidinediones, N Engl J Med., 351:1106-1118 13. Fei, J., 2012, PPAR: A Pivotal Regulator in Metabolic Syndromes, Endocrinol Metab Synd., 1:1-2

Yamagishi, S., Nakamura, K., 2006, Telmisartan, Its Potential Therapeutic Implications in Cardiometabolic Disorders, Recent Patents on Cardiovascular Drug Discovery,

-83

Katsuki, A., Sumida, Y., Gabazza, E.C., Murashima, S., Furuta, M., Araki-Sasaki, R., 2001, Homeostasis Model Assessment Is a Reliable Indicator of Insulin ResistanceDuring Follow-up of Patients With Type 2Diabetes, Diabetes Care, 24: 362–365

Mayer, E.J., Newman, B., Austin, M.A., Zhang, D., Quesenberry, C.P., Edwards, K., et al., 1996, Genetic and Environmental Influences on Insulin Levels and the Insulin Resistance Syndrome: an Analysis of Women Twins. American Journal of Epidemiology. Vol 143: 4. 323-32

Hedïng, L.G. 1988. Determination of Total Serum Insulin (IRI) in Insulin-treated Diabetic Patients.Radioimmunoassays for Insulin, C-Peptide and Proinsulin : 36-42

Kuzuya, H., Blix, P.M., Horwitz, D.L., Steiner, D.F., Rubenstein, A.H. 1977. Determination of Free and Total Insulin and C-Peptide in Insulin-treated Diabetics. Diabetes; 26: 22-29

Derosa, G., Fogari, D’Angelo, A., Cicero, A. F.G., Salvadeo, S.A.T., Ragonesi., S.T., Ferrari, I., et al. 2007. Metabolic effects of telmisartan and irbesartan in type 2diabetic patients with metabolic syndrome treated withrosiglitazone,Journal of Clinical Pharmacy and Therapeutics; 32: 261–268

Vitale, C., Mercuro, G., Castiglioni, C., Cornoldi, A., Tulli, A., Fini, M., et al., 2005, Metabolic effect of telmisartanand losartan in hypertensivepatients with metabolic syndrome, Cardiovascular Diabetology, 4: 6

DOI: https://doi.org/10.22146/acta%20interna.5731