title: Ultrasonography modifications of visceral and subcutaneous adipose tissue after pioglitazone or glibenclamide therapy combined with rosuvastatin in type 2 diabetic patients not well controlled by metformin.
abstract: OBJECTIVE
  To compare pioglitazone or glibenclamide alone and in combination with rosuvastatin on hepatic steatosis in type 2 diabetic patients.
  
  
  METHODS
  After 3 months of metformin, patients were randomized to add pioglitazone 15 mg twice a day or glibenclamide 5 mg twice a day for 6 months, and then rosuvastatin 5 mg was added for other 6 months. Patients underwent an ultrasound examination for evaluation of steatosis degree, subcutaneous adipose tissue, and visceral adipose tissue diameter, an euglycemic hyperinsulinemic clamp, and blood sample collection for evaluation of glycemic control, fasting plasma insulin, lipid profile, adipocytokines at randomization, and after 6 and 12 months.
  
  
  RESULTS
  Both pioglitazone and glibenclamide improved glycemic control. Pioglitazone reduced fasting plasma insulin, whereas glibenclamide increased it. Pioglitazone increased the glucose infusion rate compared with glibenclamide. Pioglitazone, but not glibenclamide, improved the lipid profile, and, when rosuvastatin was added, there was a greater improvement with pioglitazone and rosuvastatin. Adiponectin was increased by pioglitazone (+0.5 μg/ml), with a further increase (+0.4 μg/ml) when rosuvastatin was added. A significant decrease in leptin (-3.1 ng/ml) and interleukin-6 (-0.4 pg/ml) was found only with pioglitazone; a similar trend (-2.5 ng/ml and -0.3 pg/ml, respectively) was maintained after the addition of rosuvastatin.Rosuvastatin+pioglitazone decreased tumor necrosis factor-α (-0.3 ng/ml) and were superior to glibenclamide+rosuvastatin in reducing high-sensitivity C-reactive protein (-0.4 mg/l).Pioglitazone decreased ultrasound parameters, and the addition of rosuvastatin further decreased them both compared with randomization and glibenclamide.
  
  
  CONCLUSIONS
  Pioglitazone was more effective than glibenclamide in improving inflammation and hepatic steatosis indices.
authors.affiliation: Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
authors.forename: Pamela
authors.initials: P
authors.lastname: Maffioli
authors.forename: Elena
authors.initials: E
authors.lastname: Fogari
authors.forename: Angela
authors.initials: A
authors.lastname: D'Angelo
authors.forename: Tiziano
authors.initials: T
authors.lastname: Perrone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Derosa
mesh_terms: D054392:Adipokines / Q000097:blood; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D015992:Body Mass Index; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005234:Fatty Liver / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D005464:Fluorobenzenes / Q000627:therapeutic use*; D015309:Glucose Clamp Technique; D005905:Glyburide / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D018836:Inflammation Mediators / Q000097:blood; D007328:Insulin / Q000097:blood; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000378:metabolism; D007558:Italy; D008055:Lipids / Q000097:blood; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D000077205:Pioglitazone; D011743:Pyrimidines / Q000627:therapeutic use*; D000068718:Rosuvastatin Calcium; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000378:metabolism; D013449:Sulfonamides / Q000627:therapeutic use*; D045162:Thiazolidinediones / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D054392:Adipokines; D015415:Biomarkers; D001786:Blood Glucose; D005464:Fluorobenzenes; D007004:Hypoglycemic Agents; D018836:Inflammation Mediators; D007328:Insulin; D008055:Lipids; D011743:Pyrimidines; D013449:Sulfonamides; D045162:Thiazolidinediones; D000068718:Rosuvastatin Calcium; D008687:Metformin; D005905:Glyburide; D000077205:Pioglitazone