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Cooling down inflammation in type 2 diabetes: how strong is the evidence for cardiometabolic benefit?
Maria Ida Maiorino1, Giuseppe Bellastella2, Dario Giugliano2
1Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Endocrinology and Metabolic Diseases Unit, Second University of Naples, Piazza L. Miraglia n° 2, 80138, Naples, Italy. mariaida.maiorino@unina2.it.
Abstract:
Chronic inflammation is supposed to be an important mediator of cardiometabolic dysfunctions seen in type 2 diabetes. In this mini-review, we collected evidence (PubMed) from randomized controlled trials (through March 2016) evaluating the effect of anti-inflammatory drugs on indices of glycemic control and/or cardiovascular events in people with type 2 diabetes. Within the last 25 years, many anti-inflammatory drugs have been tested in type 2 diabetes, including hydroxychloroquine, anti-tumor necrosis factor therapies (etanercept and infliximab), salsalate, interleukin-1 antagonists (anakinra, canakinumab, gevokizumab, LY2189102), and CC-R2 antagonists. Despite being promising, the observed effects on HbA1c or glucose control remain rather modest in most clinical trials, especially with the new drugs. There are many trials underway with anti-inflammatory agents to see whether patients with cardiovascular diseases and/or type 2 diabetes may have clinical benefit from marked reductions in circulating inflammatory markers. Until now, a large trial with losmapimod (a p38 inhibitor) among patients with acute myocardial infarction, including one/third of diabetic patients, showed no reduction in the risk of major ischemic cardiovascular events. Further evidence is warranted in support of the concept that targeting inflammation pathways may ameliorate glycemic control and also reduce cardiovascular complications in type 2 diabetes.
Insights
Anti-inflammatory drugs show modest effects on glycemic control in type 2 diabetes patients. While promising, further research is needed to confirm benefits for cardiovascular complications and blood sugar management.
Area of Science:
- Endocrinology
- Cardiology
- Immunology
Background:
- Chronic inflammation is a key factor in cardiometabolic dysfunction associated with type 2 diabetes.
- Numerous anti-inflammatory drugs have been investigated for their potential to manage type 2 diabetes complications.
Purpose of the Study:
- To review evidence from randomized controlled trials on the efficacy of anti-inflammatory drugs in improving glycemic control and reducing cardiovascular events in type 2 diabetes patients.
- To assess the current status and future directions of targeting inflammation for managing type 2 diabetes.
Main Methods:
- Systematic review of randomized controlled trials published up to March 2016, sourced from PubMed.
- Evaluation of drugs including hydroxychloroquine, anti-tumor necrosis factor therapies, salsalate, interleukin-1 antagonists, and CC-R2 antagonists.
Main Results:
- Most clinical trials demonstrated only modest improvements in HbA1c or glucose control with anti-inflammatory agents.
- A trial of losmapimod (p38 inhibitor) in acute myocardial infarction patients, including those with diabetes, did not reduce major ischemic cardiovascular events.
Conclusions:
- Current evidence suggests limited clinical benefit of anti-inflammatory drugs on glycemic control in type 2 diabetes.
- Further research is required to determine if targeting inflammation pathways can effectively reduce cardiovascular complications and improve glycemic control in type 2 diabetes.
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