Add on HCQS to treatment may improve beta cell function and insulin resistance in uncontrolled diabetes
India: A recent study published in the International Journal of Diabetes in Developing Countries has shown hydroxychloroquine (HCQ) to be a safe and effective add-on anti-diabetic drug for patients uncontrolled on metformin and sulfonylurea.
The drug was shown to improve insulin resistance and beta cell function correlating significantly with improvements in markers of inflammation, i.e., interleukin-6 (IL6) and high-sensitivity C-reactive protein (hsCRP).
Beta cell dysfunction and insulin resistance are the fundamental effects in metabolism seen in type 2 diabetes (T2D) patients. Though there is a long list of drugs against diabetes, currently, there is no drug that targets and utilizes the effect on systemic inflammation to its therapeutic benefit. Hydroxychloroquine is a drug with proven anti-inflammatory properties as seen by its ability to suppress cytokine production.
The effects of HCQ on glycemic control are known, despite this, there is no complete understanding of the exact mechanism of its action. Since subclinical inflammation is tied to insulin resistance, HCQ's anti-inflammatory effect could be one of the possible pathways. Moreover, the effect on beta cell function in patients with diabetes has never been studied to the best of the knowledge of the authors.
Rajesh Rajput, Department of Endocrinology and Medicine Unit IV, Pt. B.D.S. PGIMS, Rohtak, Haryana, India, and colleagues aimed to assess the effect of HCQ on insulin resistance and beta cell function and inflammatory markers in T2D patients uncontrolled on glimepiride and metformin combination.
The study included 30 type 2 diabetes patients who were inadequately controlled on metformin and glimepiride combination with an HbA1c between 7.5 and 10%. They were given 400 mg hydroxychloroquine in addition to glimepiride and metformin during the 12-week study period. Insulin resistance, beta cell function, adiponectin, hsCRP, fasting plasma glucose (FPG), interleukin-6 (IL6), glycated haemoglobin (HbA1c), and postprandial plasma glucose (PPG) were assessed at baseline and 12 weeks after the addition of 400 mg HCQ.
The study led to the following findings:
- With the addition of HCQ, there was a significant improvement in both beta cell function and insulin resistance.
- There was also significant improvement in FPG, PPG, and HbA1c along with significant improvement in hsCRP, IL6, and adiponectin levels post 12 weeks of adjunctive treatment with hydroxychloroquine.
- The changes in insulin resistance and beta cell function correlated significantly with the changes in IL6, hsCRP, and adiponectin levels.
"The present study showed that the addition of hydroxychloroquine as an add-on drug in uncontrolled diabetes significantly improved insulin resistance and beta cell function along with significant improvement in adiponectin, IL6 levels, and hsCRP levels," the researchers wrote.
"However, there is a need for further studies recruiting a larger sample size and diverse population to further reinforce the beneficial effects of HCQ," they concluded.
Reference:
Rajput, R., Upadhyay, P., Rajput, S. et al. Effect of hydroxychloroquine on beta cell function, insulin resistance, and inflammatory markers in type 2 diabetes patients uncontrolled on glimepiride and metformin therapy. Int J Diabetes Dev Ctries 43, 955–960 (2023). https://doi.org/10.1007/s13410-023-01173-9
