Pioglitazone vs glimepiride: differential effects on vascular endothelial function in patients with type 2 diabetes

Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece.

OBJECTIVE: The aim of this study was to compare the effect of glimepiride and pioglitazone on endothelial function in patients with type 2 diabetes already on metformin. METHODS: Twenty-eight patients with type 2 diabetes already on metformin, without known cardiovascular disease, were randomized in 2 groups; glimepiride (4mg od) was added in group A (n=14) and pioglitazone (30mg od) in group B (n=14) for 6 months. Flow-mediated dilation (FMD) in the brachial artery was assessed in all patients, at baseline and at follow-up. RESULTS: The 2 groups did not differ in age (mean ± S.D., 63.6 ± 7.3 years vs 62.8 ± 7.2 years respectively), or any measured variable at baseline. Fasting glucose and glycated haemoglobin improved similarly in both groups. There were significant differences between the 2 groups in the absolute changes observed at follow-up in waist circumference, +1.86 ± 3.11cm vs -1.86 ± 1.88cm in groups A and B respectively; fasting insulin levels, +14.79 ± 12.56pmol/L vs -25.84 ± 28.09pmol/L; homeostasis model assessment (HOMA), +0.66 ± 1.01 vs -1.83 ± 1.38; HDL cholesterol levels, -0.07 ± 0.22mmol/L vs +0.14 ± 0.20mmol/L and FMD, +0.14 ± 1.09% vs +2.02 ± 2.05% (P<0.05 for all). The only independent predictor factor of the FMD improvement was treatment-induced changes in HOMA (R(2): 0.488, slope: -0.782, [95% CI: -1.128, -0.436], P=0.0001). CONCLUSIONS: In patients with type 2 diabetes already on metformin, addition of pioglitazone as compared to glimepiride, improved endothelial function despite similar glycemic control. The improvement in endothelial function was mainly due to a reduction in insulin resistance.

PMID: 19135671 [PubMed - as supplied by publisher] 

 


Papathanassiou K, Naka KK, Kazakos N, et al. Pioglitazone vs glimepiride: differential effects on vascular endothelial function in patients with type 2 diabetes. Atherosclerosis. 2008 Dec 6. [Epub ahead of print]. 

Last Modified: 2/19/2013