Efficacy of pioglitazone on glycemic control and carotid intima-media thickness in type 2 diabetes patients with inadequate insulin therapy.
Aims/Introduction:  The present study was designed to determine the effects of pioglitazone on glycemic control and atherosclerosis in patients with poorly controlled type 2 diabetes on insulin therapy.


METHODS
The study was a prospective, randomized controlled trial involving 48 patients with inadequately controlled type 2 diabetes treated with insulin. We assigned patients to oral pioglitazone titrated from 15-30 mg (n = 22) or no pioglitazone (n = 26), to be taken in addition to their glucose-lowering drugs and other medications. Daily insulin doses and numbers were recorded during the study period.


RESULTS
The adjusted mean glycosylated hemoglobin (HbA1c) values decreased significantly by 1.13 ± 1.50% and 0.55 ± 0.76% in the pioglitazone and control groups, respectively. Significant decrease of HbA1c level was observed in the pioglitazone group compared with the control group (P < 0.05). The insulin dose lowered by 0.04 ± 0.10 units/kg/day in the pioglitazone group and increased by 0.03 ± 0.10 units/kg/day in the control group (P < 0.05). The number of insulin injections decreased by 0.1 ± 0.6 times/day in the pioglitazone group and increased by 0.2 ± 0.4 times/day in the control group (P < 0.05). The carotid intima-media thickness estimated by B-mode echography was carried out in both groups and decreased significantly at the end-point only in the pioglitazone group, relative to the baseline.


CONCLUSIONS
These findings show that pioglitazone is useful in improving glycemic control and preventing the progression of atherosclerosis in poorly-controlled type 2 diabetics on insulin therapy. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00064.x, 2010).
Department of Medicine, Metabolism and Endocrinology, Juntendo University Graduate School of Medicine.
Eisuke
E
Yasunari
Department of Medicine, Metabolism and Endocrinology, Juntendo University Graduate School of Medicine.
Kageumi
K
Takeno
Funayama Clinic.
Hideaki
H
Funayama
Department of Medicine, Metabolism and Endocrinology, Juntendo University Graduate School of Medicine.
Setsuko
S
Tomioka
Department of Medicine, Metabolism and Endocrinology, Juntendo University Graduate School of Medicine.
Motoyuki
M
Tamaki
Department of Medicine, Metabolism and Endocrinology, Juntendo University Graduate School of Medicine ; Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine.
Yoshio
Y
Fujitani
Department of Medicine, Metabolism and Endocrinology, Juntendo University Graduate School of Medicine ; Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine ; Center for Beta-Cell Biology and Regeneration, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Ryuzo
R
Kawamori
Department of Medicine, Metabolism and Endocrinology, Juntendo University Graduate School of Medicine.
Hirotaka
H
Watada
Department of Medicine, Metabolism and Endocrinology, Juntendo University Graduate School of Medicine ; Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine.
Takahisa
T
Hirose
Atherosclerosis; Insulin therapy; Pioglitazone