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- Title
Up- and Down-Regulation of Serum Insulin Levels by Pioglitazone in Newly Diagnosed, Drug Naïve Patients with Type 2 Diabetes.
- Authors
Kutoh, Eiji; Wajs, Jan
- Abstract
Pioglitazone is known to down-regulate hyperinsulinemia as a result of decreased insulin resistance. However, many patients with type 2 diabetes possess substantially low insulin levels. It is significant to study its effects on insulin levels as well as other parameters with those low insulin patients. Newly diagnosed, drug naive patients with type 2 diabetes received 15-30 mg/day pioglitazone monotherapy. At 3 months, levels of fasting insulin (IRI), HbA1c, TG, and HDL-C were compared with those at baseline. The patients were divided into two groups; those with high baseline IRI (above 15 µU/ml, n=26) and others with low baseline IRI (below 7 µU/ml, n=27). It is of note that differences existed in the baseline levels of IRI (22.68+12.71 vs. 5.08+2.16 µU/ml, p<0.0001), HbA1c (9.08±2 vs. 9.95±2.21%, p<0.05), TG (224.8±167.8 vs. 165.5±119 mg/dl, p=0.14) and HDL-C (49.9±11.3 vs. 61±20 mg/dl, p<0.02) between high and low IRI groups, respectively. In the high IRI group, significant reductions of IRI were observed (-41%, p<0.001). In this group, changes of HbA1c (from 9.08±2 to 7.45±1.96%, p<0.0001), TG (-21.2%, p<0.05) and HDL-C (+9.4%, p<0.005) were observed. However, in the low IRI group, significant increases of IRI were observed (+126%, p<0.05). In this group, changes of HbA1c (from 9.95±2.21 to 8.54±1.96%, p<0.0002), TG (-21.5%, p=0.057) and HDL-C (+6.8%, p<0.001) were observed. Taken together, pioglitazone can down-regulate hyperinsulinemia but up-regulate hypoinsulinemia. The mechanism of this up-regulation may be due to improved beta-cell function from chronic insulin resistance and/or eliminated glucotoxicity/lipotoxicity with pioglitazone. In either case (high or low IRI), pioglitazone may be able to rejuvenate the history of diabetes (or beta-cell), thereby changes of insulin resistance, blood glucose and insulin levels occur as depicted in the arrows in the figure. In addition to its glucose lowering effect, pioglitazone can differentially regulate several metabolic parameters depending upon the baseline IRI levels.
- Subjects
HYPOGLYCEMIC agents; PHARMACODYNAMICS; SERUM; INSULIN; INSULIN resistance; TYPE 2 diabetes
- Publication
Diabetes, 2007, Vol 56, pA162
- ISSN
0012-1797
- Publication type
Article