Type 2 Diabetes Mellitus Exhibiting Decreased TNF-.ALPHA. and Increased Adiponectin Levels Associated with an Improvement in Hypertriglyceridemia Following Bezafibrate Treatment

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A 76-year-old female visited our clinic with suspected angina pectoris. A coronary angiography confirmed a stenosis of 75%. The patient was diagnosed as having angina pectoris, tachycardiac arrhythmia, and hyperlipidemia, and treatment with a nitrate-containing drug, a β-blocker, and HMG Co-A reductase inhibitor was started. The administration of the β-blocker produced an increase in serum triglyceride levels in the range of 500-600mg/dl, along with a corresponding increase in HbA1c. A 75-g OGTr showed her to be diabetic, with marked hyperinsulinemia. Bezafibrate administration resulted in an increase in preheparin LPL and a decrease in triglycerides to 200mg/dl, RLP-TG, small dense LDL, and MDA-LDL. The hyperinsulinemia had improved when 75-gOGTT were performed at 4, 8 and 16 weeks after the start of treatment, and the HOMA-R decreased from 8.3 to 3.3 following treatment, with a corresponding improvement in the HbA1c level. No significant changes in the leptin or PAI-1 levels occured during the treatment. However, the TNF-α and HS-CRP levels decreased, whereas the adiponectin level increased with bezafibrate treatment. In conclusion, this case demonstrated that hypertriglyceridemia is closely associated with insulin resistance through the involvement of relevant adipocytokines.
一般社団法人日本糖尿病学会の論文