AACE: Long-term Lipid Benefits of Pioglitazone for Patients with Type 2 Diabetes

Study showed an improvement in HDL as well as the lowering of triglycerides

Type 2 diabetics receiving pioglitazone for one year, at 45 mg/day showed improved high-density lipoprotein (HDL) cholesterol levels as well as lowered glycemic and triglyceride levels, researchers reported last week at the annual meeting of the American Association of Clinical Endocrinologists.

"These changes should have a positive benefit on coronary heart disease associated with diabetes," the researchers concluded.

The investigative team, led by Allen King, MD, Medical Director of the Diabetes Care Center in Salinas, California, United States, did a retrospective analysis of the charts of patients with type 2 diabetes who had received pioglitazone at 45 mg/day and whose hemoglobin A1c (HbA1c) and lipid panel values had been recorded at intervals appropriate for this retrospective analysis.

Excluded from the study were patients whose pioglitazone treatment had been interrupted and patients whose dosage of lipid lowering drug had been altered during the course of a 12-month treatment or within six weeks of the initiation of pioglitazone therapy.

Of the more than 800 patients who had received pioglitazone treatment at the center, 29 met all entry criteria. The mean duration of treatment at each interval of lipid measurement was as follows: 1.) within four weeks of initiating pioglitazone therapy; 2.) at a mean of 3.6 months of therapy; and 3.) at 11.6 months of therapy. Almost half (47 percent) of the subjects were women and 15 of the 29 subjects were also taking statin therapy. The mean age was 54.9 years.

At 12 months, the investigators found that total cholesterol and LDL cholesterol changes were small, at 3.2 percent for the former and 0 percent for the later. However, HDL cholesterol increased by 16.8 percent (p<0.01 versus baseline). Glycemic (HbA1c) readings declined by 1.30 percent units, and triglyceride readings fell by 33.9 percent (p<0.01 versus baseline).

The researchers concluded "Pioglitazone treatment seems to offer long-term benefits with regard to HDL-C and triglyceride levels.". "These durable benefits in both HDL-C and triglyceride levels are especially interesting because diabetic patients whose treatment enables them to increase HDL-C levels do not necessarily experience a decrease in triglyceride levels. It is therefore interesting to find that [pioglitazone] therapy produced benefits in both HDL-C and triglyceride levels; this long-term improvement in patient lipid profiles could ultimately result in decreased incidence of coronary heart disease."

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