The effect of glipizide, metformin and rosiglitazone on nontraditional cardiovascular risk factors in newly diagnosed patients with type 2 diabetes mellitus

Background: Diabetes mellitus (DM) is recognized as a major risk factor for cardiovascular disease (CVD). Traditional cardiovascular risk factors (CVRFs) alone cannot explain excess risk for CVD associated with DM; nontraditional CVRFs also may play an important role. Aim: To study the effects of glipizide, metformin and rosiglitazone on traditional [lipid profile, lipoprotein Lp(a)] and nontraditional CVRFs [homocysteine (Hcy), soluble Vascular Cell Adhesion Molecule (sVCAM-1), malonyldialdehyde (MDA) and nitric oxide (NO) levels]. Setting and Design: An open-label, randomized, parallel group study was conducted in the departments of pharmacology, internal medicine and biochemistry of Lady Hardinge Medical College. Materials and Methods: Ninety newly diagnosed type 2 DM patients were randomly assigned to glipizide, metformin or rosiglitazone treatment daily for a duration of 12 weeks. If needed, the dosages were titrated upward to achieve fasting plasma glucose<126 mg / dL. Plasma glucose, glycosylated hemoglobin (HbA1c), lipid profile, body mass index (BMI), Lp(a), Hcy, sVCAM-1, MDA and NO were estimated both before and after treatment. Statistical Analysis: Data were analyzed using paired Student's t-test within each group. Results and Conclusion: All the three drugs led to significant decrease in HbA1c, fasting and postprandial plasma glucose levels. Glipizide lowered body weight, BMI, total cholesterol (P<0.05), low density lipoprotein cholesterol (LDL-C) (P<0.01) and MDA levels (P<0.05). Metformin reduced body weight (P<0.01), BMI (P<0.01), LDL-C, very low density lipoprotein cholesterol (VLDL-C) and improved high density lipoprotein cholesterol (HDL-C); however, it raised Hcy levels (P<0.01). Rosiglitazone treatment increased body weight (P<0.01) and LDL-C (P<0.01); however, it improved HDL-C (P<0.01) and decreased sVCAM-1 (P<0.05) and MDA (P<0.05) levels.