Glycemic and non-glycemic effects of pioglitazone in triple oral therapy in patients with type 2 diabetes mellitus

M Dorkhan, Martin Magnusson, A Frid, A Grubb, L Groop, S Jovinge

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OBJECTIVES: To examine pioglitazone as add-on to metformin and insulin secretagogues in patients with type 2 diabetes and inadequate glycaemic control and its effect on glycaemic control, surrogate measures of insulin sensitivity (adiponectin) and beta-cell function (proinsulin/insulin) and fluid retention.

DESIGN AND SETTING: Prospective open-label study of 54 patients with type 2 diabetes and HbA1c>or=6.5% admitted to outpatient unit at Malmö University Hospital. The patients received 30-45 mg pioglitazone daily during 26 weeks in addition to their existing antidiabetic medication. After 26 weeks, one-third of patients were followed for 3 months without pioglitazone.

RESULTS: HbA1c decreased (7.8+/-0.9-6.3+/-0.9%, P<0.001) with 61% of patients achieving levels<6.5%. However, in the group followed for another 3 months HbA1c increased (6.1+/-0.73-7.1+/-0.9, n=18, P<0.001) after pioglitazone withdrawal. Adiponectin increased (6.1+/-2.8-13.2+/-5.8 microg mL-1, P<0.001) and the proinsulin to insulin ratio decreased (0.89+/-0.66-0.66+/-0.53, P<0.001). Nt-proBNP increased from 487.3+/-252.2 to 657.8+/-392.1 pmol L-1 (P<0.001).

CONCLUSIONS: Pioglitazone is effective in achieving glycaemic targets and reducing risk factors involved in atherosclerosis and improving beta-cell function when used as part of triple oral therapy in patients with type 2 diabetes and secondary drug failure. Nt-proBNP increase with concomitant decrease in haemoglobin suggests a subclinical sign of fluid retention.

Original languageEnglish
Pages (from-to)125-133
Number of pages9
JournalJournal of Internal Medicine
Issue number2
Publication statusPublished - 2006 Aug

Bibliographical note

The information about affiliations in this record was updated in December 2015.
The record was previously connected to the following departments: Pediatrics/Urology/Gynecology/Endocrinology (013240400), Hematopoietic Stem Cell Laboratory (013022012), Division of Clinical Chemistry and Pharmacology (013250300), Diabetes and Endocrinology (013241530)

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems
  • Medicinal Chemistry
  • Endocrinology and Diabetes


  • Adiponectin
  • Administration, Oral
  • Aged
  • Biomarkers
  • Blood Glucose
  • Case-Control Studies
  • Cystatin C
  • Cystatins
  • Diabetes Mellitus, Type 2
  • Drug Therapy, Combination
  • Female
  • Glyburide
  • Hemoglobin A, Glycosylated
  • Humans
  • Hypoglycemic Agents
  • Insulin
  • Male
  • Metformin
  • Middle Aged
  • Natriuretic Peptide, Brain
  • Peptide Fragments
  • Proinsulin
  • Prospective Studies
  • Statistics, Nonparametric
  • Thiazolidinediones
  • Comparative Study
  • Journal Article
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't


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