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Differential effect of pioglitazone (PGZ) and rosiglitazone (RGZ) on postprandial glucose and lipid metabolism in patients with type 2 diabetes mellitus: a prospective, randomized crossover study
Author(s) -
Chappuis Bernard,
Braun Monika,
Stettler Christoph,
Allemann Sabine,
Diem Peter,
Lumb Peter J.,
Wierzbicki Anthony S.,
James Richard,
Christ Emanuel R.
Publication year - 2007
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.715
Subject(s) - rosiglitazone , pioglitazone , postprandial , medicine , crossover study , diabetes mellitus , type 2 diabetes mellitus , endocrinology , randomized controlled trial , type 2 diabetes , alternative medicine , placebo , pathology
Abstract Background Postprandial metabolism is impaired in patients with type 2 diabetes (T2Dm). Two thiazolidinediones pioglitazone (PGZ) and rosiglitazone (RGZ) have similar effects on glycaemic control but differ in their effects on fasting lipids. This study investigated the effects of RGZ and PGZ on postprandial metabolism in a prospective, randomized crossover trial. Methods Seventeen patients with T2Dm were randomized to RGZ or PGZ for 12 weeks, with an 8‐week wash‐out period. Fasting blood samples were taken for glucose (FPG), insulin, HbA 1c , lipids, apolipoproteins (apo), lipoprotein (LPL) and hepatic lipase (HL), and cholesterol ester transfer protein (CETP) activity. A standardized breakfast was served and postprandial glucose, insulin, and lipid subfraction profiles were determined. Results RGZ and PGZ treatment resulted in a similar improvement in FPG, HbA 1c and homeostasis model assessment. Fasting and postprandial triglyceride (TG) levels were significantly lower following PGZ therapy (fasting: −0.35 vs 0.44 mmol/L; p < 0.04; postprandial AUC‐TG: −195.6 vs 127.9 mmol/L/min; p < 0.02) associated with changes in VLDL‐2‐TG (−0.10 vs 0.21 mmol/L; p = 0.23) and VLDL‐3‐TG (0.0 vs 0.34 mmol/L; p < 0.04). Fasting cholesterol increased with RGZ compared to PGZ (0.06 vs 0.59 mmol/L; p < 0.04), particularly in VLDL‐2‐C (−0.30 vs 0.59 mmol/L; p < 0.03) and VLDL‐3‐C (−0.85 vs 2.11 mmol/L; p < 0.02). Postprandial VLDL lipid and protein content increased after RGZ and decreased after PGZ. Fasting apoB, apoA‐I, apoC‐II/C‐III‐ratio, and LPL activity did not differ. CETP activity decreased after RGZ and increased after PGZ (−6.2 vs 4.2 p /mol/mL/min; p < 0.002). Conclusions Both the glitazones had similar effects on glucose metabolism. The additional beneficial effect of PGZ on lipid metabolism may be related to its effects on insulin‐independent VLDL production and CETP activity. Copyright © 2007 John Wiley & Sons, Ltd.