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Cited by 86Lipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and LipoproteinsLipid metabolism and disorders

A comparison between the effects of gemfibrozil and simvastatin on insulin sensitivity in patients with non-insulin-dependent diabetes mellitus and hyperlipoproteinemia

Öhrvall, Margareta, Lithell, Hans, Johansson, Jan, Vessby, Bengt·1995·Metabolism
DOI 10.1016/0026-0495(95)90267-8
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Abstract

In a double-blind, randomized crossover study, 29 patients with non-insulin-dependent diabetes mellitus (NIDDM) and hyperlipoproteinemia were treated with gemfibrozil (1,200 mg/d) or simvastatin (10 mg/d) for 4 months. After gemfibrozil treatment, the insulin concentration was increased during the major part of the intravenous glucose tolerance test (IVGTT) and during the hyperinsulinemic euglycemic clamp. Similar but less pronounced elevations were caused by simvastatin. Insulin sensitivity decreased by 27% and 28% during gemfibrozil and simvastatin treatment, respectively. Low-density lipoprotein (LDL) cholesterol was decreased with simvastatin treatment by 24%. The LDL cholesterol level was not changed by gemfibrozil, but very-low-density lipoprotein (VLDL) cholesterol was reduced by 40%. The VLDL triglyceride concentration was reduced to a significantly greater extent by gemfibrozil. After gemfibrozil treatment, lipoprotein(a) [Lp(a)] was decreased by 24%, and the plasma free fatty acid (FFA) concentration was increased by 20% and skeletal muscle lipoprotein lipase activity (LPLA) by 37%. Although simvastatin more effectively decreased LDL cholesterol levels and the LDL to high-density lipoprotein (HDL) ratio, it cannot be claimed unreservedly that this drug is necessarily preferable in NIDDM patients. Gemfibrozil improved triglyceride removal and decreased VLDL concentrations, with qualitative changes in LDL. The apparent effects on insulin sensitivity are difficult to evaluate and need further study.

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  • Statin treatment has been reported to impair insulin sensitivity and increase type 2 diabetes prevalence, with lipophilic statins having a stronger effect than hydrophilic statins.

    “Recently, it has been reported that statin treatment impairs insulin sensitivity and increases the prevalence of type 2 diabetes (19 -22); and it seems that lipophilic statins (i.e., simvastatin, atorvastatin, fluvastatin, lovastatin) have a more pronounced effect on insulin sensitivity compared with hydrophilic statins (i.e., pravastatin, rosuvastatin) (23).”

    From Simvastatin Effects on Skeletal Muscle (2013) · cites this paper as [21]

  • Prior studies by Koh et al. used the Quantitative Insulin-Sensitivity Check Index as a surrogate measure for insulin sensitivity, while Ohrvall et al. used the hyperinsulinemic-euglycemic clamp technique.

    “The 3 studies by Koh et al. (19,20,22) from 2008, 2009, and 2010 used the Quantitative Insulin-Sensitivity Check Index as a surrogate measure for insulin sensitivity, whereas the study by Ohrvall et al. (21) from 1995 used the hyperinsulinemic-euglycemic clamp technique.”

    From Simvastatin Effects on Skeletal Muscle (2013) · cites this paper as [21]

  • The Ohrvall et al. study was conducted in patients with type 2 diabetes, which may confound its results.

    “The latter study was performed in patients with type 2 diabetes, which could be a confounding factor.”

    From Simvastatin Effects on Skeletal Muscle (2013) · cites this paper as [21]

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Authors
Öhrvall, M., Lithell, H., Johansson, J., & Vessby, B.
Affiliations
Uppsala University (SE)
Venue
Metabolism
Publisher
Elsevier BV
Published
1995-02
Volume
44
Issue
2
Pages
212-217
ISSN
0026-0495 (ISSN-L)
DOI
10.1016/0026-0495(95)90267-8
OpenAlex
W2073264025
Cited by
86
References
35
Citations by year
2020: 3 · 2019: 1 · 2017: 4 · 2016: 2 · 2015: 1 · 2014: 2 · 2013: 3 · 2012: 2
FWCI
3.83
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
Keywords
gemfibrozil, simvastatin, insulin sensitivity, type 2 diabetes, hyperlipoproteinemia, LDL cholesterol, VLDL cholesterol, triglycerides, lipoprotein(a), free fatty acids, lipoprotein lipase, statins, fibrates
MeSH terms
Aged, Hypolipidemic Agents, Body Weight, Diabetes Mellitus, Double-Blind Method, Female, Glucose Tolerance Test, Humans, Hyperlipoproteinemias, Insulin, Lipoprotein Lipase, Lipoproteins, LDL, Lipoproteins, VLDL, Lovastatin, Male, Middle Aged, Gemfibrozil, Lipoprotein(a), Simvastatin, Diabetes Complications

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