Adipose tissue and diabetes therapy: do we hit the target?

Area of Science:

• Endocrinology
• Metabolic Syndrome
• Vascular Biology

Background:

• Adipose tissue factors significantly influence diabetes development and vascular complications.
• Key factors include free fatty acids, adipocytokines, thrombotic/antifibrinolytic agents, and adiponectin.
• Insulin resistance and vascular function are directly impacted by these adipose-derived mediators.

Purpose of the Study:

• To evaluate antidiabetic treatment strategies based on their impact on adipose tissue-derived risk factors.
• To assess the efficacy of various treatments in improving metabolic parameters and reducing vascular risk.

Main Methods:

• Analysis of existing literature on antidiabetic agents and their effects on adipose tissue factors.
• Comparison of treatment strategies concerning improvements in insulin resistance, vascular function, and related biomarkers.

Main Results:

• Weight loss is a highly effective strategy for mitigating multiple adipose tissue-derived risk factors.
• Thiazolidinediones and rimonabant show potent effects on numerous adipose factors, but mortality data are pending.
• Metformin has minimal impact on adipose factors but shows some evidence of reducing diabetes-related mortality.
• Sulfonylureas and insulin offer limited benefits on adipose factors, primarily acting through glucose metabolism improvement.

Conclusions:

• Interventions targeting adipose tissue factors are crucial for managing diabetes and its vascular sequelae.
• Lifestyle modifications, particularly weight loss, offer substantial benefits.
• Pharmacological agents vary in their efficacy regarding adipose-derived factors, necessitating further research on long-term outcomes like mortality.