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Moon, Kim, Kim, Shim, Kang, Rhee, Ahn, Lim, Kim, Lee, and Cha: Long-term Effect of Pioglitazone Treatment in Patients with Type 2 Diabetes
Original Article
The Journal of Korean Diabetes Association

The Journal of Korean Diabetes Association 2006; 30(4): 264-276.

Published online: 31 July 2006

DOI: https://doi.org/10.4093/jkda.2006.30.4.264

Long-term Effect of Pioglitazone Treatment in Patients with Type 2 Diabetes

Jae Hoon Moon, Hye Jin Kim, Soo Kyung Kim1, Wan Sub Shim, Eun Seuk Kang, Yumie Rhee, Chul Woo Ahn, Sung Kil Lim, Kyung Rae Kim, Hyun Chul Lee, Bong Soo Cha

Department of Internal Medicine, Yonsei University College of Medicine, Korea.

1Department of Internal Medicine1, Pochon CHA Univercity College of Medicine, Korea.

Received 13 September 2005       Accepted 5 July 2006

Copyright © 2006 Korean Diabetes Association

Abstract

Background

Type 2 diabetes is characterized by impaired insulin secretion and/or insulin resistance. Thiazolidinediones have been shown to ameliorate insulin resistance. The purpose of the present study was to evaluate the long term serial effect of pioglitazone on anthropometrics and metabolic parameters in Korean type 2 diabetes patients.

Methods

One hundred thirteen type 2 diabetes patients (male, 67; female, 46; mean age, 49.1 ± 10.8 years) were evaluated before and after 3 months, 6 months and 12 months of treatment with pioglitazone (Actos™, 15 mg/day). Anthropometric parameters and metabolic variables were measured.

Results

Body weight and body mass index (BMI) were increased in 3 months after pioglitazone treatment (body weight, 68.8 ± 12.2 vs 69.8 ± 11.9 kg, p < 0.01) without further increase. In women, body weight and BMI tended to increase more (body weight change after 3 months, 0.6 ± 1.7 kg vs 1.6 ± 1.7 kg, p < 0.01) and longer (3 months vs 6 months) than in men. Fasting plasma glucose (FPG) and HbA1c were decreased in 3 months after pioglitazone treatment (FPG, 7.97 ± 2.29 vs 6.94 ± 2.01 mmol/L, p < 0.01; HbA1c, 7.7 ± 1.5 vs 7.0 ± 1.1%, p < 0.01). Hypoglycemic effect of pioglitazone was prominent in women than in men (FPG change after 12 months, -1.80 ± 2.54 vs -0.09 ± 1.72 mmol/L, p < 0.001; HbA1c change after 12 months, -0.9 ± 1.3 vs -0.4 ± 1.1%, p < 0.05). Serum high-density lipoprotein cholesterol was increased after 3 months of pioglitazone treatment (1.16 ± 0.24 vs 1.31 ± 0.28 mmol/L, p < 0.01) without return until the end of this study. Serum triglycerides level decreased at 3 months (basal vs 3 months, 2.29 ± 1.86 vs 1.88 ± 1.21 mmol/L, p < 0.01) and 6 months (basal vs 6 months, 2.29 ± 1.86 vs 1.97 ± 1.40 mmol/L, p < 0.05) of pioglitazone treatment, but returned to basal level at 12 months. Liver enzyme, especially serum alanine transferase level decreased after 3 months of pioglitazone treatment (30.8 ± 23.7 vs 24.5 ± 18.5 IU/L, p < 0.01) without return until the end of this study. Hypoglycemic effect of pioglitazone was associated with basal BMI, fat contents and serum leptin level.

Conclusion

Korean type 2 diabetes patients with pioglitazone use showed favorable metabolic effect for glycemic control, lipid metabolism and liverfunction, but pioglitazone induced body weight increase may be limited.

Keywords: Anthropometrics, Pioglitazone, Thiazolidinedione

Figures and Tables

Fig. 1
Changes of body weight and BMI after pioglitazone treatment.
A. Total study patients (n = 113). B. Male (n = 67) and female (n = 46) study patients. BMI, body mass index.
*p < 0.01.
jkda-30-264-g001
Fig. 2
Hypoglycemic effects after pioglitazone treatment.
A. Total study patients (n = 113). B. Male (n = 67) and female (n = 46) study patients. FPG, fasting plasma glucose; HbAlc, glycosylated hemoglobin.
*p < 0.01.
jkda-30-264-g002
Fig. 3
Changes in lipid profiles after pioglitazone treatment (n = 113).
HDL, high density lipoprotein.
*p < 0.01 versus baseline.
†p < versus baseline.
jkda-30-264-g003
Fig. 4
Changes in liver enzymes after pioglitazone treatment (n = 113).
AST, aspertate transaminase; ALT, alanine transminase.
*p < 0.01.
jkda-30-264-g004
Fig. 5
Correaltions between △FPG and basal parameters.
△FPG, 12 months fasting plasma glucose-baseline fasting plasma glucose; BMI, body mass index.
jkda-30-264-g005
Fig. 6
Changes of body weight and BMI after pioglitazone treatment in each oral hypoglycemic agent use.
SU, sulfonylurea use (n = 21); Met, metformin use (n = 53); SU+Met, sulfonylurea + metformin use (n = 39); BMI, body mass index.
*p < 0.01.
jkda-30-264-g006
Table 1
Baseline Characteristics of Subjects
jkda-30-264-i001

Data are expressed as means ± SD.; BMI, body mass index; WHR, waist to hip circumference ratio; HbA1c, glycosylated hemoglobin; FPg, fasting plasma glucose; HDL, high density lipoprotein; LDL, low density lipoprotein; AST, aspartate transaminase; ALT, alanine transaminase; HOMA-IR, homeostasis model assessment insulin resistanace; SFT, subcutaneous fat thickness; VFT, visceral fat thickness; VSR, the ratio of VFT to SFT; SU, sulfonylurea.

*p < 0.05 male versus female.

Table 2
Changes of Body Weight and BMI after Pioglitazone Treatment
jkda-30-264-i002

Data are expressed as means ± SD.; BMI, body mass index.

*p < 0.01 versus baseline.

†p < versus 3 months.

Table 3
Changes of Anthropometrics after 3 Months of Pioglitazone Treatment (n = 113)
jkda-30-264-i003

Data are expressed as means ± SD.; SFT, subcutaneous fat thickness; VFT, visceral fat thickness; VSR, the ration of VFT to SFT.

Table 4
Changes of FPG and Hba1c Levels, and HOMA-IR Indices after Pioglitazone Treatment
jkda-30-264-i004

Data are expressed as means ± SD.; FPG, fasting plasma glucose; HbA1c, glycosylated hemoglobin; HOMA-IR, homeostasis model assessment insulin resistanace.

*p < 0.01 versus baseline.

Table 5
Changes in Lipid Profiles after Pioglitazone Treatment (n = 13)
jkda-30-264-i005

Data are expressed as means ± SD.

HDL, high density lipoprotein; LDL, low density lipoprotein.

*p < 0.01 versus baseline.

†p < 0.05 versus baseline.

Table 6
Changes in Liver Enzymes after Pioglitazone Treatment (n = 113)
jkda-30-264-i006

Data are expressed as means ± SD.

AST, aspertate transaminase; ALT, alanine transminase.

*p < 0.01 versus baseline.

Table 7
Changes of Body Weight and BMI after Pioglitazone Treatment in Each Oral Hypoglycemic Agent Use
jkda-30-264-i007

Data are expressed as means ± SD.

BMI, body mass index; SU, sulfonylurea.

*p < 0.01 versus baseline.

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