Glycemic and non-glycemic effects of pioglitazone in triple oral therapy in patients with type 2 diabetes mellitus

Summary, in English

OBJECTIVES: To examine pioglitazone as add-on to metformin and insulin secretagogues in patients with type 2 diabetes and inadequate glycaemic control and its effect on glycaemic control, surrogate measures of insulin sensitivity (adiponectin) and beta-cell function (proinsulin/insulin) and fluid retention.

DESIGN AND SETTING: Prospective open-label study of 54 patients with type 2 diabetes and HbA1c>or=6.5% admitted to outpatient unit at Malmö University Hospital. The patients received 30-45 mg pioglitazone daily during 26 weeks in addition to their existing antidiabetic medication. After 26 weeks, one-third of patients were followed for 3 months without pioglitazone.

RESULTS: HbA1c decreased (7.8+/-0.9-6.3+/-0.9%, P<0.001) with 61% of patients achieving levels<6.5%. However, in the group followed for another 3 months HbA1c increased (6.1+/-0.73-7.1+/-0.9, n=18, P<0.001) after pioglitazone withdrawal. Adiponectin increased (6.1+/-2.8-13.2+/-5.8 microg mL-1, P<0.001) and the proinsulin to insulin ratio decreased (0.89+/-0.66-0.66+/-0.53, P<0.001). Nt-proBNP increased from 487.3+/-252.2 to 657.8+/-392.1 pmol L-1 (P<0.001).

CONCLUSIONS: Pioglitazone is effective in achieving glycaemic targets and reducing risk factors involved in atherosclerosis and improving beta-cell function when used as part of triple oral therapy in patients with type 2 diabetes and secondary drug failure. Nt-proBNP increase with concomitant decrease in haemoglobin suggests a subclinical sign of fluid retention.

• Author: M Dorkhan; Martin Magnusson; A Frid; A Grubb; L Groop; S Jovinge
• Department/s: Translational Muscle Research; Cardiovascular Research - Hypertension; Department of Clinical Sciences, Malmö; Division of Clinical Chemistry and Pharmacology; Stem Cell Center
• Publishing year: 2006-08
• Language: English
• Pages: 125-133
• Publication/Series: Journal of Internal Medicine
• Volume: 260
• Issue: 2
• Full text: - 150 kB; Download statistics
• Links: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16882276&dopt=Abstract; http://dx.doi.org/10.1111/j.1365-2796.2006.01665.x
• Document type: Journal article
• Publisher: Wiley-Blackwell
• Topic: Cardiac and Cardiovascular Systems; Medicinal Chemistry; Endocrinology and Diabetes
• Keywords: Adiponectin; Administration, Oral; Aged; Biomarkers; Blood Glucose; Case-Control Studies; Cystatin C; Cystatins; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Female; Glyburide; Hemoglobin A, Glycosylated; Humans; Hypoglycemic Agents; Insulin; Male; Metformin; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Proinsulin; Prospective Studies; Statistics, Nonparametric; Thiazolidinediones; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
• Status: Published
• Research group: Genomics, Diabetes and Endocrinology; Cardiovascular Research - Hypertension
• ISBN/ISSN/Other: ISSN: 1365-2796