This article originally posted 24 July, 2007 and appeared in Issue 374
Type 2’s Improve Cardiovascular Risk After Switching From Insulin to Pioglitazone/Glimepiride
In a poster presentation at the ADA 67th Scientific Sessions, Type 2 diabetic patients switched from insulin to a combination of pioglitazone and glimepiride achieved blood glucose control and showed improvement in cardiovascular risk.
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The researchers switched the 32 women and 66 men enrolled in the study from insulin therapy to pioglitazone/glimepiride after confirming residual beta-cell function using a glucagon stimulation test. The subjects had a mean age of 59 years, disease duration of 5.6 years, mean body mass index (BMI) of 33.9, and hemoglobin A1c (HbA1c) level of 6.9 mg/dL.
Observation parameters at baseline and endpoint included HbA1c, homeostasis model assessment to predict insulin resistance (HOMA-IR), IV glucose tolerance test (GTT), United Kingdom Prospective Diabetes Study cardiovascular risk score (UKPDS), adiponectin, high-sensitivity C-reactive protein (hsCRP), matrix metalloproteinases 9 (MMP9), monocyte chemoattractant protein 1 (MCP-1), and soluble CD40 ligand (sCD40L).
Subjects showing an increase in HbA1c >0.5 % at any timepoint were removed from the study (n = 23, 23%). The remaining 75 patients achieved stable HbA1c values, with a baseline mean of 6.8% and an endpoint mean of 6.7%.
Among the 75 subjects, the researchers found parallel and statistically significant improvements in HOMA-IR, adiponectin, hsCRP, and MCP-1 as well as nonsignificant improvements in the IV GTT sensitivity index, UKPDS risk score, and MMP9. They observed no change in sCD40L.
"The majority of patients switched from insulin to pioglitazone/glimepiride treatment responded not only with a stable glycemic control but also with an improved cardiovascular risk profile after 6 months of therapy," the investigators concluded.
The study was supported by Takeda Pharma. International Journal of Clinical Practice Vol. 61 Page 1 June 2007 s153, Oral combination therapy with thiazolidinediones and sulfonylureas in type 2 diabetes
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