Rosiglitazone reduces liver fat and insulin requirements and improves hepatic insulin sensitivity and glycemic control in patients with type 2 diabetes requiring high insulin doses.

Description

Studies have shown that the degree of fat accumulation in the liver is an important determinant of insulin requirements during insulin therapy. Because peroxisome proliferator-activated receptor (PPAR)-gamma agonists have been shown to reduce liver fat content, Juurinen et al. hypothesized that patients with type 2 diabetes using exceptionally high doses of insulin might be particularly responsive to PPAR-gamma agonist treatment and that the treatment would markedly reduce insulin requirements and liver fat and improve hepatic insulin sensitivity. They therefore determined the effect of the PPAR-gamma agonist rosiglitazone on liver fat and directly measured hepatic insulin sensitivity in 14 patients with type 2 diabetes who were poorly controlled despite high-dose insulin therapy combined with metformin. Study results indicated that treatment with rosiglitazone decreased glycosylated haemoglobin, insulin requirements, and liver fat content in these patients. Moreover, hepatic insulin sensitivity, as measured based on the suppression of endogenous glucose production by insulin, increased significantly. These findings suggest that rosiglitazone may be particularly effective in patients with type 2 diabetes who are poorly controlled despite using unusually high doses of insulin. In addition, the authors proposed that the mechanism behind these results likely involves reduced liver fat and enhanced hepatic insulin sensitivity.