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Effect of pioglitazone compared with glimepiride on carotid intima-media thickness in type 2 diabetes: a randomized
Theodore Mazzone1, Peter M Meyer, Steven B Feinstein
1Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Illinois College of Medicine, Chicago 60612, USA. tmazzone@uic.edu
JAMA
|November 15, 2006
Summary
Pioglitazone significantly slowed carotid artery intima-media thickness (CIMT) progression in type 2 diabetes mellitus (DM) patients compared to glimepiride over 18 months. This suggests pioglitazone may offer cardiovascular benefits in type 2 DM.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Pharmacology
Background:
- Carotid artery intima-media thickness (CIMT) is a key indicator of atherosclerosis and cardiovascular risk, particularly elevated in type 2 diabetes mellitus (DM).
- Previous short-term studies suggested thiazolidinediones, like pioglitazone, may slow CIMT progression in diabetic patients, but longer-term data were inconclusive.
Purpose of the Study:
- To compare the efficacy of pioglitazone versus glimepiride in altering common carotid artery CIMT in patients with type 2 DM.
- To assess the long-term impact of these antidiabetic agents on subclinical atherosclerosis progression.
Main Methods:
- A randomized, double-blind, multicenter trial involving 462 adults with type 2 DM over 72 weeks.
- Participants received either pioglitazone (15-45 mg/d) or glimepiride (1-4 mg/d) as an active comparator.
- Changes in mean posterior-wall CIMT were measured using automated edge-detection technology from carotid ultrasound images.
Main Results:
- Pioglitazone demonstrated a significantly slower progression of mean CIMT compared to glimepiride at 72 weeks (difference: -0.013 mm; P = .02).
- Progression of maximum CIMT was also significantly reduced with pioglitazone versus glimepiride (difference: -0.024 mm; P = .008).
- The beneficial effects of pioglitazone on CIMT were consistent across various patient subgroups.
Conclusions:
- Over an 18-month period, pioglitazone effectively slowed the progression of CIMT in patients with type 2 DM when compared to glimepiride.
- These findings support a potential role for pioglitazone in mitigating subclinical atherosclerosis in this patient population.
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