title: Effect of exenatide, insulin and pioglitazone on bone metabolism in patients with newly diagnosed type 2 diabetes.
abstract: OBJECTIVE
  Preclinical studies suggested that insulin, incretin and thiazolidinediones had effect on regulation of bone metabolism. But clinical evidence is limited. We assessed the effects of these antihyperglycemic agents on bone metabolism in patients with newly diagnosed type 2 diabetes.
  
  
  METHODS
  The present study was a two-center, randomized, parallel-group clinical trial. Sixty-two newly diagnosed and drug-naïve patients with type 2 diabetes were randomized to exenatide (EXE, n = 20), mixed protamine zinc recombinant human insulin lispro injection (25R; INS, n = 21) or pioglitazone (PIO, n = 21) group for a 24-week treatment. Glycosylated hemoglobin A1c (HbA1c), body weight, body mineral density (BMD) and fasting serum concentration of bone turnover markers including osteocalcin (OC), C-telopeptide of type I collagen (CTX) and tartrate-resistant alkaline phosphatase 5b (TRAcP5b) were assessed at baseline and week 24.
  
  
  RESULTS
  Baseline characteristics were similar among groups. At week 24, HbA1c improved in all patients (EXE:-2.4 ± 0.3 %, INS:-2.4 ± 0.3 %, PIO:-2.0 ± 0.2 %; p > 0.05 among groups). Patients treated with exenatide lost body weight remarkably (-4.7 ± 0.8 kg). In spite of the amelioration of glucose control, no significant improvement of OC, CTX or TRAcP5b was observed at week 24 (EXE: OC -0.619 ± 0.728 ng/ml, CTX 0.147 ± 0.046 ng/ml, TRAcP5b 0.302 ± 0.149 U/L;INS: OC 0.637 ± 0.787 ng/ml, CTX -0.012 ± 0.074 ng/ml, TRAcP5b 0.124 ± 0.395 U/L; PIO: OC -0.150 ± 0.691 ng/ml, CTX 0.073 ± 0.094 ng/ml, TRAcP5b 0.586 ± 0.183 U/L; p > 0.05), as well as BMD measurement, regardless of the treatments.
  
  
  CONCLUSIONS
  Twenty-four-week treatment with exenatide, insulin and pioglitazone improved glucose control in patients with newly diagnosed type 2 diabetes, but had no impact on bone turnover markers or BMD.
authors.affiliation: Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Renyuan
authors.initials: R
authors.lastname: Li
authors.affiliation: Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Sihui
authors.initials: S
authors.lastname: Luo
authors.affiliation: Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Haixia
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China.
authors.forename: Guoyu
authors.initials: G
authors.lastname: Tong
authors.affiliation: Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Longyi
authors.initials: L
authors.lastname: Zeng
authors.affiliation: Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China.
authors.forename: Dalong
authors.initials: D
authors.lastname: Zhu
authors.affiliation: Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. wjianp@mail.sysu.edu.cn.
authors.forename: Jianping
authors.initials: J
authors.lastname: Weng
mesh_terms: D000328:Adult; D000368:Aged; D001835:Body Weight; D015519:Bone Density; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism*; D024042:Collagen Type I; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000378:metabolism*; D000077270:Exenatide; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000378:metabolism; D010455:Peptides / Q000627:therapeutic use*; D000077205:Pioglitazone; D000071681:Tartrate-Resistant Acid Phosphatase / Q000378:metabolism; D045162:Thiazolidinediones / Q000627:therapeutic use*; D014688:Venoms / Q000627:therapeutic use*
chemical_list: D024042:Collagen Type I; D000077270:Exenatide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D015675:Osteocalcin; D010455:Peptides; D000077205:Pioglitazone; D000071681:Tartrate-Resistant Acid Phosphatase; D045162:Thiazolidinediones; D014688:Venoms; C052929:collagen type I trimeric cross-linked peptide
keywords: Bone mineral density; Bone turnover marker; Exenatide; Insulin; Newly diagnosed type 2 diabetes; Pioglitazone