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Comparison of glycaemic control over 1 year with pioglitazone or gliclazide in patients with Type 2 diabetes
Author(s) -
Perriello G.,
Pampanelli S.,
Pietro C.,
Brunetti P.
Publication year - 2006
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2006.01801.x
Subject(s) - pioglitazone , gliclazide , medicine , type 2 diabetes , diabetes mellitus , insulin resistance , endocrinology , insulin
Aims To compare long‐term (1 year) efficacy and safety of pioglitazone and gliclazide in patients with Type 2 diabetes. Methods This was a double‐blind, multicentre, comparative, parallel group trial in 283 patients with Type 2 diabetes, who were randomized to receive 1‐year treatment with pioglitazone 30–45 mg/day or gliclazide 80–320 mg/day. Drug dose was titrated on the basis of self‐monitored blood glucose (SMBG) measurements and HbA 1c values. The 1‐year changes in HbA 1c , fasting blood glucose (FBG), insulin, HOMA‐S (HOmeostatic Model Assessment) and SMBG were compared. In a subgroup of patients ( n = 10), systemic glucose production and utilization were determined by a combination of isotopic (deuterated glucose) and clamp techniques. Results In both groups, there were similar decreases in HbA 1c (pioglitazone: −0.79%; gliclazide: −0.79%) and FBG (pioglitazone: −1.0 mmol/l; gliclazide: −0.7 mmol/l), whereas the slope of the reduction of fasting blood glucose was different between groups ( P = 0.004). Insulin levels as well as insulin resistance assessed using HOMA‐S decreased significantly only after pioglitazone treatment (−11.94 pmol/l and −1.03, respectively, both P = 0.002 vs. baseline). A significantly greater reduction in systemic glucose production was observed in the pioglitazone group (−2.48 µmol/kg/min, P = 0.042) than in the gliclazide group (−1.02 µmol/kg/min). A few, mild adverse events occurred in both groups. Conclusions A comparable decrease in HbA 1c and FBG was observed with pioglitazone and gliclazide. However, with pioglitazone there was a continuous decrease in FBG over 1 year, whereas gliclazide failed to maintain a similar trend. This favourable effect of pioglitazone was due to its insulin‐sensitizing effect and ability to decrease systemic glucose production.