The impact of pioglitazone on glycemic control and atherogenic dyslipidemia in patients with type 2 diabetes mellitus

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BackgroundTo evaluate the glycemic control, lipid effects, and safety of pioglitazone in patients with type 2 diabetes mellitus.Design and methodsPatients (n  = 197) with type 2 diabetes mellitus, a hemoglobin A1c (HbA1c) ≥ 8.0%, fasting plasma glucose (FPG)  > 7.7 mmol/l (140 mg/dl), and C-peptide  > 0.331 nmol/l (1 ng/ml) were enrolled in this 23-week multi-center (27 sites), double-blind clinical trial and randomized to receive either a placebo or pioglitazone HCl 30 mg (pioglitazone), administered once daily, as monotherapy. Patients were required to discontinue all anti-diabetic medications 6 weeks before receiving study treatment. Efficacy parameters included HbA1c, fasting plasma glucose (FPG), serum C-peptide, insulin, triglycerides (Tg), and cholesterol (total cholesterol [TC], high-density lipoprotein-cholesterol [HDL-C], low-density lipoprotein-cholesterol [LDL-C]). Adverse event rates, serum chemistry, and physical examinations were recorded.ResultsCompared with placebo, pioglitazone significantly (P  = 0.0001) reduced HbA1c ( −1.37% points), FPG ( −3.19 mmol/L;  −57.5 mg/dl), fasting C-peptide ( −0.076 ± 0.022 nmol/l), and fasting insulin ( −11.88 ± 4.70 pmol/l). Pioglitazone significantly (P  < 0.001) decreased insulin resistance (HOMA-IR;  −12.4 ± 7.46%) and improved β-cell function (Homeostasis Model Assessment (HOMA-BCF);  +47.7 ± 11.58%). Compared with placebo, fasting serum Tg concentrations decreased ( −16.6%;P  = 0.0178) and HDL-C concentrations increased ( +12.6%;P  = 0.0065) with pioglitazone as monotherapy. Total cholesterol and LDL-C changes were not different from placebo. The overall adverse event profile of pioglitazone was similar to that of placebo, with no evidence of drug-induced elevations of serum alanine transaminase (ALT) concentrations or hepatotoxicity.Conclusionsimproved insulin resistance and glycemic control, as well as Tg and HDL-C–which suggests that pioglitazone may reduce cardiovascular risk for patients with type 2 diabetes.

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