Background and aims: Thiazolidinediones have been extensively used as second line agents in the management of type 2 diabetes. A small increased incidence of ischaemic heart disease was suggested by a meta-analysis of studies using Rosiglitazone. Similar meta-analysis of Pioglitazone did not show adverse cardiovascular outcomes. Our aim was to objectively evaluate the changes in glycaemic and lipid control in a controlled conversion from Rosiglitazone to Pioglitazone.
Materials and methods: Thirty-five patients identified from Primary and Secondary care were converted from Rosiglitazone (4 or 8 mg) to equivalent dose Pioglitazone (30 or 45 mg). Blood tests taken at baseline and 3 to 6 months late for fasting plasma glucose, HbA1c, liver function tests, full lipid profile and creatinine. Apolipoprotein-B total cholesterol:HDL and non-HDL were taken as additional markers of cardiovascular risk. Patients requiring additional treatment changes for their glycaemic or lipid control during this period were excluded from the analysis.
Results: Using paired Wilcoxon two-tailed, conversion from Rosiglitazone to Pioglitazone resulted in a significant improvement in mean fasting plasma glucose from median of 7.8 to 6.3 mmol/l (P=0.005) and median HbA1c from 7.2 to 6.8% (P=0.0001). Lipid parameters also showed a significant improvement with median total cholesterol falling from 4.1 to 3.9 mmol/l (P=0.0013), and HDL cholesterol from 1.0 to 1.2 mmol/l (P=0.0008) with non-HDL levels falling from 3.1 to 2.6 mmol/l (P<0.0001). Overall total cholesterol:HDL cholesterol fell from 3.9 to 3.4 with P<0.0001. ApoB levels (20 cases) improved from 0.7 to 0.6 g/l (P=0.0023). Improvement in triglycerides was also significant (1.61.1 mmol/l, P=0.0179).
Conclusions: Our data in a real clinical setting suggests that Pioglitazone is more effective than Rosiglitazone at plasma glucose control. Pioglitazone also showed better lipid profiles. There is clinical merit in converting patients to Pioglitazone.
Prague, Czech Republic
24 - 28 Apr 2010
European Society of Endocrinology