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Background  China has the highest absolute disease burden of diabetes worldwide. For diabetic patients, diabetes-related vascular complications are major causes of morbidity and mortality. The roles of lipoprotein-associated phospholipase A 2  (Lp-PLA 2 ) and secretory phospholipase A 2  (sPLA 2 ) as inflammatory markers have been recently evaluated in the pathogenesis of both diabetes and atherosclerosis. We aimed to determine the mechanism through which patients with newly diagnosed type 2 diabetes gain long-term vascular benefit from intensive insulin therapy by evaluating the change in Lp-PLA 2  and sPLA 2  levels after early intensive insulin treatment and its relevance with insulin resistance and pancreatic β-cell function.    Methods  In total, 90 patients with newly diagnosed type 2 diabetes mellitus were enrolled. All patients received continuous subcutaneous insulin infusion (CSII) for approximately 2 weeks. Intravenous glucose-tolerance test (IVGTT) and oral glucose-tolerance test (OGTT) were performed, and plasma concentrations of Lp-PLA 2  and sPLA 2  were measured before and after CSII.    Results  Levels of Lp-PLA 2  and sPLA 2  were significantly higher in diabetic patients with macroangiopathy than in those without ( P  < 0.05). After CSII, the sPLA 2  level decreased significantly in all diabetic patients ( P  < 0.05), while the Lp-PLA2 level changed only in those with macroangiopathy ( P  < 0.05). The area under the curve of insulin in IVGTT and OGTT, the acute insulin response (AIR 3–5 ), early phase of insulin secretion (ΔIns30/ΔG30), modified β-cell function index, and homeostatic model assessment for β-cell function (HOMA-β) increased after treatment even when adjusted for the influence of insulin resistance (IR;  P  < 0.001). The HOMA-IR was lower after treatment, and the three other indicators adopted to estimate insulin sensitivity (ISI ced , IAI, and QUICKI) were higher after treatment ( P  < 0.05). Correlation analysis showed that the decrease in the Lp-PLA 2  and sPLA 2  levels was positively correlated with a reduction in HOMA-IR after CSII ( P  < 0.05). Additionally, multiple linear regression analysis showed that Lp-PLA 2  and sPLA 2  independently correlated with HOMA-IR ( P  < 0.05).    Conclusions  Lp-PLA 2  and sPLA 2  are closely related to insulin resistance and macroangiopathy in diabetic patients. Intensive insulin therapy might help improve IR and protect against diabetic macroangiopathy by influencing the Lp-PLA 2  and sPLA 2  levels.    Trial registration    ChiCTR-TRC-10001618  2010 September 16.

lipids in health and disease

Effect of intensive insulin treatment on plasma levels of lipoprotein-associated phospholipase A2 and secretory phospholipase A2 in patients with newly diagnosed type 2 diabetes