Renal function preservation with pioglitazone or with basal insulin as an add-on therapy for patients with type 2 diabetes mellitus.
OBJECTIVE
Clinical outcome may differ owing to the distinct pharmacological characteristics of insulin sensitizers and insulin. This study was performed to compare the metabolic and renal function changes with add-on pioglitazone treatment versus basal insulin in patients with type 2 diabetes mellitus (DM) in whom sulfonylurea and metformin regimens failed.


METHODS
Patients who were consecutively managed in the diabetes comprehensive program with add-on pioglitazone or detemir/glargine treatment for at least 2 years following sulfonylurea and metformin treatment failure were included.


RESULTS
A total of 1002 patients were enrolled (pioglitazone: 559, detemir: 264, glargine: 179). After propensity score matching, there were 105 patients with matchable baseline characteristics in each group. After a mean of 3.5 years of follow-up, the pioglitazone group showed a greater HbA1c reduction than the detemir group and the glargine group. Despite patients in all three groups exhibiting significant body weight gain, those in the pioglitazone group and the glargine group showed greater body weight increases than the patients in the detemir group (2.1, 1.6 and 0.8 kg, respectively, p < 0.05). Interestingly, Cox regression analysis indicated that patients under detemir or glargine treatment had a higher probability of CKD progression as compared with the pioglitazone group, with hazard ratios of 2.63 (95% CI 1.79-3.88) and 3.13 (95% CI 2.01-4.87), respectively.


CONCLUSIONS
Our study first showed that treatment with both pioglitazone and basal insulin improved glycemic control, while only pioglitazone treatment was observed to be advantageous in terms of preserving renal function when used as an add-on therapy for patients with type 2 DM in whom sulfonylurea and metformin regimens failed.
Department of Internal Medicine, Lee's Endocrinology Clinic, # 130 Min-Tzu Rd, Pingtung, 90000, Taiwan. yuhungchang@so-net.net.tw.
Yu-Hung
http://orcid.org/0000-0001-6116-1893
YH
Chang
Department of Internal Medicine, Lee's Endocrinology Clinic, # 130 Min-Tzu Rd, Pingtung, 90000, Taiwan.|Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Der-Wei
DW
Hwu
Department of Internal Medicine, Lee's Endocrinology Clinic, # 130 Min-Tzu Rd, Pingtung, 90000, Taiwan.
Dao-Ming
DM
Chang
Department of Medical Education, Beijing Ruijing Diabetes Hospital, Beijing, 100078, China.
Ling-Wang
LW
An
Division of Endocrinology and Metabolism, Department of Internal MedicineNational Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan.
Chang-Hsun
CH
Hsieh
Department of Internal Medicine, Lee's Endocrinology Clinic, # 130 Min-Tzu Rd, Pingtung, 90000, Taiwan.
Yau-Jiunn
YJ
Lee
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000473:pathology / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000494:pharmacology; D000069057:Insulin Detemir / Q000008:administration & dosage* / Q000494:pharmacology; D007668:Kidney / Q000187:drug effects* / Q000502:physiology; D007677:Kidney Function Tests; D008875:Middle Aged; D000077205:Pioglitazone; D045162:Thiazolidinediones / Q000008:administration & dosage* / Q000494:pharmacology; D016896:Treatment Outcome
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069057:Insulin Detemir; D000077205:Pioglitazone; D045162:Thiazolidinediones
Basal insulin; Pioglitazone; Renal function; Type 2 diabetes mellitus