title: Comparative effects of metformin and pioglitazone on YKL-40 in type 2 diabetes: a randomized clinical trial.
abstract: OBJECTIVE
  Metformin and pioglitazone are believed to exert their long-term benefits by means of amelioration of chronic low-grade inflammation, a key event in development of diabetes and its long-term complications. The present trial was designed to investigate the comparative efficacy of the two anti-diabetes medications on serum concentrations of YKL-40, a novel marker of inflammation.
  
  
  METHODS
  In a parallel-group, open-label, randomized trial setting (ClinicalTrials.gov Identifier No. NCT01521624), 84 newly diagnosed, medication-naïve type 2 diabetes patients were assigned to metformin 1,000 mg daily (n = 42) or pioglitazone 30 mg daily (n = 42). Serum concentrations of YKL-40, along with highly sensitive C-reactive protein, indices of glycemic control and lipid profile were measured at baseline and after 3 months.
  
  
  RESULTS
  In the analyzed sample (metformin = 40, pioglitazone = 42), both medications were equally effective with regard to control of hyperglycemia, and hsCRP reduction (p > 0.05). However, metformin caused a significant decline in weight (p = 0.005), BMI (p = 0.004), and total cholesterol levels (p = 0.028) of the patients. Metformin also significantly reduced YKL-40 concentrations after 3 months (1.90 ± 17 vs. 1.66 ± 0.15 µg/L, p = 0.019). The amount of change in the pioglitazone arm did not reach statistical significance (2.18 ± 0.14 vs. 2.25 ± 0.16 µg/L, p = 0.687). When compared, metformin was significantly more effective than pioglitazone with respect to YKL-40 reduction in both univariate (p = 0.020, effect size = 6.7%) and multivariate models (p = 0.047, effect size = 5.7%).
  
  
  CONCLUSIONS
  Metformin is more effective in reduction of YKL-40 concentration in short term and the effect seems to be independent of degree of glycemic control, or hsCRP reduction.
authors.affiliation: Endocrinology and Metabolism Research Center (EMRC), School of Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran, esteghamati@tums.ac.ir.
authors.forename: A
authors.initials: A
authors.lastname: Esteghamati
authors.forename: S
authors.initials: S
authors.lastname: Rezvani
authors.forename: E
authors.initials: E
authors.lastname: Khajeh
authors.forename: M
authors.initials: M
authors.lastname: Ebadi
authors.forename: M
authors.initials: M
authors.lastname: Nakhjavani
authors.forename: S
authors.initials: S
authors.lastname: Noshad
mesh_terms: D054392:Adipokines / Q000037:antagonists & inhibitors* / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D000071451:Chitinase-3-Like Protein 1; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use; D037102:Lectins / Q000037:antagonists & inhibitors* / Q000097:blood*; D008297:Male; D008687:Metformin / Q000494:pharmacology / Q000627:therapeutic use*; D008875:Middle Aged; D000077205:Pioglitazone; D045162:Thiazolidinediones / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D054392:Adipokines; D015415:Biomarkers; C084533:CHI3L1 protein, human; D000071451:Chitinase-3-Like Protein 1; D007004:Hypoglycemic Agents; D037102:Lectins; D045162:Thiazolidinediones; D008687:Metformin; D000077205:Pioglitazone