title: Effects of bed-time insulin versus pioglitazone on abdominal fat accumulation, inflammation and gene expression in adipose tissue in patients with type 2 diabetes.
abstract: OBJECTIVE
  Intra-abdominal fat (IAF) and inflammatory markers are correlated with cardio-vascular risk. We compared the impact of bed-time insulin versus pioglitazone treatment on these parameters in type 2 diabetic (T2D) patients.
  
  
  METHODS
  Twenty-eight T2D patients poorly controlled with metformin and sulfonylurea were randomized to receive add-on therapy with pioglitazone or bed-time NPH insulin. IAF and subcutaneous fat (SCF) content, systemic low-grade inflammation level and expression of inflammation related genes in SCF, were measured before and after 24 weeks of treatment.
  
  
  RESULTS
  Insulin and pioglitazone resulted in a significant decrease in HbA1c (-1.6% and -1.2%, respectively) and a significant increase in total body fat mass (1+/-2.3 and 3.3+/-2.7 kg, respectively). There was no change in IAF content after both treatments whereas significant increase in SCF content was only seen after pioglitazone treatment (p<0.05 versus insulin). hsCRP level decreased after pioglitazone and ferritin level decreased after insulin treatment. No change in mRNA expression of inflammation related genes was found after either treatment.
  
  
  CONCLUSIONS
  This suggests that a 24-week treatment with pioglitazone or bed-time insulin has a similar impact on intra-abdominal fat mass and systemic low-grade inflammation.
authors.affiliation: University Pierre et Marie Curie-Paris 6, School of Medicine, Paris 75006, France. agnes.hartemann@psl.ap-hop-paris.fr
authors.forename: Agnès
authors.initials: A
authors.lastname: Hartemann-Heurtier
authors.forename: Marine
authors.initials: M
authors.lastname: Halbron
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Golmard
authors.forename: Sophie
authors.initials: S
authors.lastname: Jacqueminet
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Bastard
authors.forename: Christine
authors.initials: C
authors.lastname: Rouault
authors.forename: Amine
authors.initials: A
authors.lastname: Ayed
authors.forename: Laurence
authors.initials: L
authors.lastname: Pieroni
authors.forename: Karine
authors.initials: K
authors.lastname: Clément
authors.forename: André
authors.initials: A
authors.lastname: Grimaldi
mesh_terms: D000273:Adipose Tissue / Q000187:drug effects* / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD / Q000235:genetics; D015214:Antigens, Differentiation, Myelomonocytic / Q000235:genetics; D001823:Body Composition / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D018932:Chemokine CCL2 / Q000235:genetics; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use; D007249:Inflammation / Q000188:drug therapy*; D007328:Insulin / Q000494:pharmacology / Q000627:therapeutic use; D015850:Interleukin-6 / Q000235:genetics; D050152:Intra-Abdominal Fat / Q000187:drug effects*; D008297:Male; D008687:Metformin / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D020133:Reverse Transcriptase Polymerase Chain Reaction; D055815:Young Adult; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D018932:Chemokine CCL2; D007004:Hypoglycemic Agents; D007328:Insulin; D015850:Interleukin-6; D008687:Metformin; C111835:CCL2 protein, human; C067980:CD68 antigen, human; D000097382:CD68 Molecule