BACKGROUND: We aimed to assess the effect of long-term pioglitazone treatment on erythropoietin responsiveness and insulin resistance in type 2 diabetic patients on hemodialysis. METHODS: We conducted a prospective, open-label, parallel-group, controlled study of 63 type 2 diabetic hemodialysis patients who were randomly assigned to two groups: pioglitazone group (P-group; 15-30 mg/day pioglitazone plus conventional oral hypoglycemic agents) and control group (C-group; conventional oral hypoglycemic agents alone). We determined the efficacy of pioglitazone by monitoring anemia, glycemic control, insulin resistance, and levels of inflammatory cytokines and high-molecular-weight (HMW) adiponectin for 96 weeks. RESULTS:Pioglitazone effectively reduced erythropoietin dose and maintained the target hemoglobin levels by improving insulin resistance up to the end of the study. In the P-group, hemoglobin A(1c), glycated albumin, and triglycerides significantly decreased compared with the C-group. There was a significant reduction in homeostasis model assessment for insulin resistance and the level of high-sensitivity C-reactive protein, and a significant increase in HMW adiponectin level in the P-group; these changes were significantly different compared with values for the C-group. No serious adverse effects such as hypoglycemia, liver impairment, or heart failure were observed in any of the patients. CONCLUSION:Pioglitazone treatment resulted in better glycemic control, improved lipid levels, an increase in insulin sensitivity and adiponectin levels, and a decrease in inflammatory markers, thus improving the risk factors of cardiovascular disease. Erythropoietin responsiveness improved with a reduction in erythropoietin dose and may be associated with the improvement in insulin resistance due to long-term pioglitazone treatment.
RCT Entities:
BACKGROUND: We aimed to assess the effect of long-term pioglitazone treatment on erythropoietin responsiveness and insulin resistance in type 2 diabeticpatients on hemodialysis. METHODS: We conducted a prospective, open-label, parallel-group, controlled study of 63 type 2 diabetic hemodialysispatients who were randomly assigned to two groups: pioglitazone group (P-group; 15-30 mg/day pioglitazone plus conventional oral hypoglycemic agents) and control group (C-group; conventional oral hypoglycemic agents alone). We determined the efficacy of pioglitazone by monitoring anemia, glycemic control, insulin resistance, and levels of inflammatory cytokines and high-molecular-weight (HMW) adiponectin for 96 weeks. RESULTS:Pioglitazone effectively reduced erythropoietin dose and maintained the target hemoglobin levels by improving insulin resistance up to the end of the study. In the P-group, hemoglobin A(1c), glycated albumin, and triglycerides significantly decreased compared with the C-group. There was a significant reduction in homeostasis model assessment for insulin resistance and the level of high-sensitivity C-reactive protein, and a significant increase in HMW adiponectin level in the P-group; these changes were significantly different compared with values for the C-group. No serious adverse effects such as hypoglycemia, liver impairment, or heart failure were observed in any of the patients. CONCLUSION:Pioglitazone treatment resulted in better glycemic control, improved lipid levels, an increase in insulin sensitivity and adiponectin levels, and a decrease in inflammatory markers, thus improving the risk factors of cardiovascular disease. Erythropoietin responsiveness improved with a reduction in erythropoietin dose and may be associated with the improvement in insulin resistance due to long-term pioglitazone treatment.
Authors: Suetonia C Palmer; Britta Tendal; Reem A Mustafa; Per Olav Vandvik; Sheyu Li; Qiukui Hao; David Tunnicliffe; Marinella Ruospo; Patrizia Natale; Valeria Saglimbene; Antonio Nicolucci; David W Johnson; Marcello Tonelli; Maria Chiara Rossi; Sunil V Badve; Yeoungjee Cho; Annie-Claire Nadeau-Fredette; Michael Burke; Labib I Faruque; Anita Lloyd; Nasreen Ahmad; Yuanchen Liu; Sophanny Tiv; Tanya Millard; Lucia Gagliardi; Nithin Kolanu; Rahul D Barmanray; Rita McMorrow; Ana Karina Raygoza Cortez; Heath White; Xiangyang Chen; Xu Zhou; Jiali Liu; Andrea Flores Rodríguez; Alejandro Díaz González-Colmenero; Yang Wang; Ling Li; Surya Sutanto; Ricardo Cesar Solis; Fernando Díaz González-Colmenero; René Rodriguez-Gutierrez; Michael Walsh; Gordon Guyatt; Giovanni F M Strippoli Journal: BMJ Date: 2021-01-13
Authors: Katherine R Tuttle; George L Bakris; Rudolf W Bilous; Jane L Chiang; Ian H de Boer; Jordi Goldstein-Fuchs; Irl B Hirsch; Kamyar Kalantar-Zadeh; Andrew S Narva; Sankar D Navaneethan; Joshua J Neumiller; Uptal D Patel; Robert E Ratner; Adam T Whaley-Connell; Mark E Molitch Journal: Diabetes Care Date: 2014-10 Impact factor: 19.112