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Exp Clin Endocrinol Diabetes 2005; 113(1): 49-52
DOI: 10.1055/s-2004-830527
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Effect of Pioglitazone on Lipids in Well Controlled Patients with Diabetes Mellitus Type 2 - Results of a Pilot Study

K. G. Parhofer1 , C. Otto1 , H. C. Geiss1 , E. Laubach1 , B. Göke1
  • 1Department of Internal Medicine II, Großhadern, Ludwig-Maximilians University, Munich, Germany
Further Information

Publication History

Received: December 12, 2003 First decision: March 25, 2004

Accepted: June 28, 2004

Publication Date:
21 January 2005 (online)

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Abstract

Introduction: Patients with diabetes mellitus type 2 are characterized by a typical dyslipoproteinemia. Improvement in glucose control usually also ameliorates this dyslipoproteinemia. It is unclear whether different antidiabetic strategies differ in their effects on the lipid profile. Particularly, it is unknown whether glitazones improve lipid values independently of their effects on glucose metabolism.

Methods: Ten patients well controlled on sulfonylureas (HbA1c 6.9 ± 0.5 %) with diabetic dyslipoproteinemia were treated with additional pioglitazone (30 mg/d) for 3 months. Every 4 weeks the sulfonylurea dose was adjusted to keep HbA1c and fasting glucose constant. Before and after 3 months of pioglitazone therapy lipid metabolism was determined in detail (cholesterol, triglyceride, LDL-cholesterol, HDL-cholesterol, VLDL-cholesterol, VLDL-triglycerides, lipoprotein(a), LDL-subtype distribution by isopycnic density gradient ultracentrifugation).

Results: Although glucose control remained unchanged (HbA1c 6.9 ± 0.5 % vs. 6.8 ± 0.6 %; fasting glucose concentration 7.7 ± 1.1 vs. 7.3 ± 1.3 mmol/l) we observed a significant reduction in triglyceride concentration (1.9 ± 0.6 vs. 1.4 ± 0.5 mmol/l, - 26 %, p < 0.01), a significant increase in HDL-cholesterol concentration (1.2 ± 0.2 vs. 1.4 ± 0.2 mmol/l, + 14 %, p < 0.05), a significant decrease in LDL/HDL-ratio (3.03 ± 0.77 vs. 2.51 ± 0.61, - 24 %, p < 0.05) and non-significant improvements in total cholesterol, LDL-cholesterol, VLDL-triglycerides, and VLDL-cholesterol concentrations. The LDL-subtype profile improved (significant reduction [- 20 %] in small dense LDL).

Conclusions: This pilot study indicates that at comparable fasting glucose concentration and at comparable HbA1c value pioglitazone is superior to sulfonylureas concerning the improvement of diabetic dyslipoproteinemia. Whether this relates to indirect effects (improvement in insulin sensitivity) or direct effects (stimulation of PPARα) remains to be determined.

Key words

Diabetic dyslipoproteinemia - glitazone - LDL-subtype - small dense LDL - thiazolidinedione

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MD Klaus G. Parhofer

Medical Department II - Großhadern
University of Munich

Marchioninistraße 15

81377 Munich

Germany

Phone: + 498970953010

Fax: + 49 89 70 95 88 79

Email: Klaus.Parhofer@med.uni-muenchen.de

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