Comparison of Lipid and Glycemic Effects of Pioglitazone and Rosiglitazone in Patients With Type 2 Diabetes and Dyslipidemia

• Published in: Diabetes care Vol. 28; no. 7; pp. 1547 - 1554
• Main Authors: Goldberg, Ronald B, Kendall, David M, Deeg, Mark A, Buse, John B, Zagar, Anthony J, Pinaire, Jane A, Tan, Meng H, Khan, Mehmood A, Perez, Alfonso T, Jacober, Scott J
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.07.2005
• Subjects: Aged; Apolipoproteins B - blood; Biological and medical sciences; Blood Glucose - drug effects; Blood Glucose - metabolism; C-Peptide - blood; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Comparative analysis; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Hyperlipidemias - blood; Hypoglycemic Agents - therapeutic use; Lipids; Lipids - blood; Male; Medical sciences; Middle Aged; Pioglitazone; Placebos; Prescription drugs; Rosiglitazone; Side effects; Thiazolidinediones - therapeutic use; Triglycerides - blood; Endocrinopathy; Type 2 diabetes; Human; Pioglitazone; Rosiglitazone; Metabolic diseases; Lipids; Thiazolidinedione derivatives; Dyslipemia; Comparative study; Glycemia
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.28.7.1547

OBJECTIVE:--Published reports suggest that pioglitazone and rosiglitazone have different effects on lipids in patients with type 2 diabetes. However, these previous studies were either retrospective chart reviews or clinical trials not rigorously controlled for concomitant glucose- and lipid-lowering therapies. This study examines the lipid and glycemic effects of pioglitazone and rosiglitazone. RESEARCH DESIGN AND METHODS--We enrolled subjects with a diagnosis of type 2 diabetes (treated with diet alone or oral monotherapy) and dyslipidemia (not treated with any lipid-lowering agents). After a 4-week placebo washout period, subjects randomly assigned to the pioglitazone arm (n = 400) were treated with 30 mg once daily for 12 weeks followed by 45 mg once daily for an additional 12 weeks, whereas subjects randomly assigned to rosiglitazone (n = 402) were treated with 4 mg once daily followed by 4 mg twice daily for the same intervals. RESULTS:--Triglyceride levels were reduced by 51.9 ± 7.8 mg/dl with pioglitazone, but were increased by 13.1 ± 7.8 mg/dl with rosiglitazone (P < 0.001 between treatments). Additionally, the increase in HDL cholesterol was greater (5.2 ± 0.5 vs. 2.4 ± 0.5 mg/dl; P < 0.001) and the increase in LDL cholesterol was less (12.3 ± 1.6 vs. 21.3 ± 1.6 mg/dl; P < 0.001) for pioglitazone compared with rosiglitazone, respectively. LDL particle concentration was reduced with pioglitazone and increased with rosiglitazone (P < 0.001). LDL particle size increased more with pioglitazone (P = 0.005). CONCLUSIONS:--Pioglitazone and rosiglitazone have significantly different effects on plasma lipids independent of glycemic control or concomitant lipid-lowering or other antihyperglycemic therapy. Pioglitazone compared with rosiglitazone is associated with significant improvements in triglycerides, HDL cholesterol, LDL particle concentration, and LDL particle size.