Response to insulin-resistance%u2013 oriented treatment

A 71-year-old woman presented to our unit with a “new” manifestation of type 2 diabetes mellitus after having changed primary care physicians. Her screening blood glucose level was 320 mg/dL. The other laboratory values were as follows: body mass index (BMI), 28.4 kg/m2; glycosylated hemoglobin (A1C), 11.4%; fasting blood glucose, 298 mg/dL; triglycerides, 3.21 mmol/L; low-density lipoprotein (LDL) cholesterol, 6.43 mmol/L; high-density lipoprotein (HDL) cholesterol, 1.04 mmol/L; high-sensitivity C-reactive protein (hsCRP), 5.4 mg/L (high cardiovascular risk, > 3 mg/L); intact proinsulin, 17.6 pmol/L (elevation indicating advanced-stage beta-cell dysfunction); and adiponectin, 6.4 mg/L (suppression indicating insulin resistance and increased cardiovascular risk). The patient had cardiac arrhythmia in her youth but showed no signs or symptoms of cardiovascular deterioration. Given the degree of A1C elevation, it was suspected that the disease was already prevalent and had been undetected for several years.

Treatment was initiated with diet and exercise recommendations, metformin (1,000 mg), and pioglitazone (beginning with 30 mg after 14 days of metformin, increasing to 45 mg after 4 weeks). Laboratory tests showed the following values, which improved within the first 6 weeks and were almost normalized after 3 months: BMI, 26.8 mmol/L; A1C, 7.2%; fasting glucose, 114 mg/dL; triglycerides, 1.44 mmol/L; LDL cholesterol, 3.3 mmol/L; HDL cholesterol, 1.44 mmol/L; hsCRP, 1.64 mg/dL (intermediate risk, 1—3 mg/L); intact proinsulin, 6.5 pmol/L (normal levels, < 11 pmol/L), and adiponectin, 44.2 mg/L (elevation leading to vasoprotective and anti-inflammatory effects). This case shows the degree of cardiovascular biomarker response that can be expected within the first 3 months of treatment when effective insulin-resistance–oriented antidiabetic therapy is used.