Comparisons between Pioglitazone vs. Glimerpiride on progression of coronary atherosclerosis in patients with type 2 diabetes
A study recently published in JAMA express highlighted the comparison between two diabetic treatments on progression of coronary atherosclerosis in patients with type 2 diabetes. Up until this point, no study has shown an antidiabetic regimen to reduce the progression of atherosclerosis.
Commonly used glucose lowering agents include the sulfonyureas (ie. Glimerpiride), which are insulin secretagogues and thiazolidinediones, which are insulin sensitizers.
The objective of this study was to compare one type of drug, a secretagogue, with an insulin sensitizer in the measurement of coronary progression. The study design was a double-blind, randomized, multicenter trial including 543 patients with type 2 diabetes and coronary disease.The study participants were randomized to receive either glimepiride, 1-4 mg or pioglitazone (i.e. Actos), 15-45 mg, for 18 months with titration to maximum dosage. Atherosclerosis progression was measured by repeat intravascular ultrasonography examination in 360 patients at study completion.
The conclusion of this study was that in patients who are known to have type 2 diabetes and coronary disease, treatment with pioglitazone (i.e. Actos) resulted in a significantly lower rate of atherosclerotic progression when compared to glimepiride. Since cardiovascular disease represents the cause of death in 75% of patients with diabetes, studies of this nature are important to the medical and diabetic community, in particular. It was noted that these results cannot be assumed to be a “class effect” of thiazolidinediones. The only other agent in this class, rosiglitazone, increases LDL by approximately 18% and has less favorable effects on triglycerides and HDLs. In addition, rosiglitazone increases risk of myorcardial infarction or other ischemic events as observed in several meta-analyses.
About the Author
Kathy Shattler received her Master of Science degree from Michigan State University in E. Lansing Michigan in Human Nutrition. Her twenty-two years of practice includes holding positions as a Lecturer, Chief Clinical Dietitian and Program Manager. Kathy is the Founder of Nutri-Care Consulting and is currently the Nutrition Director of www.CEU4U.COM, an online continuing education management company for Registered Dietitians and Dietetic Technicians.
