Efficacy of pioglitazone on glycemic control and carotid intima‐media thickness in type 2 diabetes patients with inadequate insulin therapy

Aims/Introduction:  The present study was designed to determine the effects of pioglitazone on glycemic control and atherosclerosis in patients with poorly controlled type 2 diabetes on insulin therapy. Materials and Methods:  The study was a prospective, randomized controlled trial involving 48 patients with inadequately controlled type 2 diabetes treated with insulin. We assigned patients to oral pioglitazone titrated from 15–30 mg ( n  = 22) or no pioglitazone ( n  = 26), to be taken in addition to their glucose‐lowering drugs and other medications. Daily insulin doses and numbers were recorded during the study period. Results:  The adjusted mean glycosylated hemoglobin (HbA 1c ) values decreased significantly by 1.13 ± 1.50% and 0.55 ± 0.76% in the pioglitazone and control groups, respectively. Significant decrease of HbA 1c level was observed in the pioglitazone group compared with the control group ( P  < 0.05). The insulin dose lowered by 0.04 ± 0.10 units/kg/day in the pioglitazone group and increased by 0.03 ± 0.10 units/kg/day in the control group ( P  < 0.05). The number of insulin injections decreased by 0.1 ± 0.6 times/day in the pioglitazone group and increased by 0.2 ± 0.4 times/day in the control group ( P  < 0.05). The carotid intima‐media thickness estimated by B‐mode echography was carried out in both groups and decreased significantly at the end‐point only in the pioglitazone group, relative to the baseline. Conclusions:  These findings show that pioglitazone is useful in improving glycemic control and preventing the progression of atherosclerosis in poorly‐controlled type 2 diabetics on insulin therapy. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00064.x, 2010)