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The Effect of Rosiglitazone on Overweight Subjects With Type 1 Diabetes

Response to Strowig and Raskin

From the Department of Epidemiology, Diabetes and Lipid Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania

Address correspondence to Trevor J. Orchard, MD, MMedSci, Department of Epidemiology, Diabetes and Lipid Research, Graduate School of Public Health, University of Pittsburgh, 3512 Fifth Ave., Pittsburgh, PA 15213. E-mail: tjo{at}pitt.edu

The recent report by Strowig and Raskin (1) raises the intriguing issue as to whether some type 1 diabetic patients may benefit from a supplementary insulin sensitization approach to their management. As our and other studies have shown that an estimate of insulin sensitivity (eGDR) is strongly predictive of mortality (2), coronary artery disease events (3), coronary calcification (4), and overt nephropathy (5) in type 1 diabetes, we would strongly endorse further pursuit of this approach.

The eGDR measure is based on a regression equation (with terms for waist-to-hip ratio, hypertension status, and HbA_1c, i.e., eGDR = 24.39 – 12.97 [waist-to-hip ratio] – 3.39 [hypertension] – 0.60 [HbA_1c]) derived from 24 hyperinsulinemic-euglycemic clamp studies and has an r² of 0.63 for measured glucose disposal rate (6). As eGDR might therefore be a useful identifier of those who would benefit from thiazolidinedione therapy, it would be helpful to know if eGDR predicted response to rosiglitazone therapy in terms of HbA_1c in the Strowig and Raskin (1) study. In addition, was there any difference in change of waist circumference (or waist-to-hip ratio) by treatment group, consistent with the observation (7) that weight gain with rosiglitazone is mainly peripheral rather than central? Finally, it is notable that lipid concentrations were not generally affected by rosiglitazone therapy in contrast to blood pressure. This is similar to our eGDR studies wherein lipids did not help to predict glucose disposal rate, but hypertension status did (6). Do these dual observations thus suggest that in type 1 diabetes insulin resistance is more strongly linked to blood pressure than to lipids?

Footnotes

T.J.O. has received grant/research support from GlaxoSmithKline.

References

1. Strowig SM, Raskin P: The effect of rosiglitazone on overweight subjects with type 1 diabetes. Diabetes Care 28:1562–1567, 2005[Abstract/Free Full Text]
   
2. Olson JC, Erbey JR, Williams KV, Becker DJ, Edmundowicz D, Kelsey SF, Sutton-Tyrrell K, Orchard TJ: Subclinical atherosclerosis and estimated glucose disposal rate as predictors of mortality in type 1 diabetes. Ann Epidemiol12:331–337, 2002[Medline]
   
3. Orchard TJ, Olson JC, Erbey JR, Williams K, Forrest KY, Smithline Kinder L, Ellis D, Becker DJ: Insulin resistance-related factors, but not glycemia, predict coronary artery disease in type 1 diabetes: 10-year follow-up data from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Care 26:1374–1379, 2003[Abstract/Free Full Text]
   
4. Dabelea D, Kinney G, Snell-Bergeon JK, Hokanson JE, Eckel RH, Ehrlich J, Garg S, Hamman RF, Rewers M: Effect of type 1 diabetes on the gender difference in coronary artery calcification: a role for insulin resistance? The Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study. Diabetes 52:2833–2839,2003
   
5. Orchard TJ, Chang Y, Ferrell R, Petro N, Ellis D: Nephropathy in type 1 diabetes: a manifestation of insulin resistance and multiple genetic susceptibilities? Further evidence from the Pittsburgh Epidemiology of Diabetes Complication Study. Kidney Int 62:963–970, 2002[Medline]
   
6. Williams KV, Erbey JR, Becker D, Arslanian S, Orchard TJ: Can clinical factors estimate insulin resistance in type 1 diabetes? Diabetes 49:626–632, 2000[Abstract]
   
7. Carey DG, Cowin GJ, Galloway GJ, Jones NP, Richard JC, Biswas N, Doddrell DM: Effect of rosiglitazone on insulin sensitivity and body composition in type 2 diabetic patients. Obes Res 10:1008–1015, 2002 [erratum in Obes Res 10:following TOC, 2002][Medline]
   

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				S. M. Strowig and P. Raskin The Effect of Rosiglitazone on Overweight Subjects With Type 1 Diabetes: Response to Orchard Diabetes Care, March 1, 2006; 29(3): 747 - 747. [Full Text] [PDF]

This Article Extract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Orchard, T. J. Search for Related Content PubMed PubMed Citation Articles by Orchard, T. J. Social Bookmarking                What's this?