Treatment with the thiazolidinedione pioglitazone leads to improvements in arterial stiffness as well as glycemic control in patients with Type 2 diabetes, report researchers.

“Patients with Type 2 diabetes mellitus have a high risk of developing both microvascular and macrovascular disease, showing a two- to four-fold increase of coronary heart disease compared with the general population,” explain Junichi Hayashi (Kyorin University, Tokyo, Japan) and team.

“Intensive glycemic control is able to reduce microvascular complications, but its effect on macrovascular changes and cardiovascular disease is rather limited,” they add.

In this study, the researchers investigated the effects of pioglitazone compared with insulin, a sulfonylurea, and a diet and exercise regime, on arterial stiffness in 204 individuals with Type 2 diabetes.

The prospective, non-randomized, open-label trial involved a follow-up period of 56 months. All patients were initially assigned to the diet and exercise regime, of whom 50 responded and therefore remained in this group.

Patients who had poor glucose control were given a sulfonylurea (n=46), pioglitazone 7.5??”30 mg/day (n=41), or insulin (n=67), depending on their diabetic profile.

Arterial stiffness was measured using the arterial stiffness index (ASI), which is based on analysis of the pulse wave amplitude pattern obtained during automated blood pressure measurement in the upper limb.

Writing in the journal Metabolism: Clinical and Experimental, the team report that although glycated hemoglobin (HbA1c) was reduced in all four groups at study completion, the ASI decreased significantly in the pioglitazone group only.

HbA1c decreased by 1.0%, 0.8%, 0.1%, and 1.5% from baseline in the pioglitazone, sulfonylurea, insulin, and diet/exercise groups, respectively.

ASI was significantly reduced from 108 at baseline to 91 at study completion in the pioglitazone group, but changes in ASI at 56 months in the other three groups were not significantly different from baseline.

Of note, triglycerides, low-density lipoprotein cholesterol, and total cholesterol were reduced in all four groups at study completion compared with baseline, and pioglitazone also increased high-density lipoprotein cholesterol to a small degree.

“Our present findings suggest that long-term pioglitazone therapy could be useful for preventing macrovascular complications due to both the direct vascular effects of this agent and its influence on glucose and lipid metabolism,” conclude Hayashi et al.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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