AIM: To evaluate the effects of intensive insulin therapy alone and with added pioglitazone on body weight, fat distribution, lean body mass (LBM) and liver fat in type 2 diabetic patients. METHODS:Twenty-five insulin-treated, obese patients with type 2 diabetes were randomized to addition of pioglitazone 45 mg (n = 12) or placebo (n = 13) and treated intensively for 12-16 weeks. Dual-energy X-ray absorptiometry/abdominal computed tomography scans were performed before/after treatment. LBM, visceral/subcutaneous adipose tissue (VAT/SAT) and liver/spleen (L/S) attenuation ratios were measured pre-/posttreatment (a ratio <1 represents fatty liver). RESULTS:Intensive insulin alone and insulin + pioglitazone significantly improved glycaemic control (7.8 ± 0.3 to 7.2 ± 0.3% and 7.6 ± 0.3 to 7.1 ± 0.4%, respectively). Body weight gain was greater with insulin + pioglitazone (4.9 ± 4.5 kg) versus insulin therapy alone (1.7 ± 0.7 kg). SAT increased significantly with pioglitazone + insulin therapy (393.9 ± 48.5 to 443.2 ± 56.7 cm(2) , p < 0.01) compared to a non-significant increase with insulin therapy alone (412.9 ± 42.5 to 420.8 ± 43.8 cm(2) ). VAT decreased non-significantly in both groups (240.3 ± 41.7 to 223.8 ± 38.1 cm(2) with insulin + pioglitazone and 266.6 ± 27.4 to 250.5 ± 22.2 cm(2) with insulin therapy). LBM increased significantly by 1.92 ± 0.74 kg with insulin + pioglitazone treatment. The L/S attenuation ratio in the placebo + insulin group decreased from 1.08 ± 0.1 to 1.04 ± 0.1 (p = ns) and increased from 1.00 ± 0.1 to 1.08 ± 0.05 (p = 0.06) in the pioglitazone + insulin group. CONCLUSIONS: Intensification of insulin therapy in type 2 diabetic patients causes modest weight gain and no change in body fat distribution, LBM or liver fat. In contrast, the addition of pioglitazone, at equivalent glycaemia, increases weight gain, fat mass and SAT; increases LBM and tends to decrease liver fat. These changes in fat distribution may contribute to the beneficial effects of pioglitazone, despite greater weight gain. Published 2011. This article is a US Government work and is in the public domain in the USA.
RCT Entities:
AIM: To evaluate the effects of intensive insulin therapy alone and with added pioglitazone on body weight, fat distribution, lean body mass (LBM) and liver fat in type 2 diabeticpatients. METHODS: Twenty-five insulin-treated, obesepatients with type 2 diabetes were randomized to addition of pioglitazone 45 mg (n = 12) or placebo (n = 13) and treated intensively for 12-16 weeks. Dual-energy X-ray absorptiometry/abdominal computed tomography scans were performed before/after treatment. LBM, visceral/subcutaneous adipose tissue (VAT/SAT) and liver/spleen (L/S) attenuation ratios were measured pre-/posttreatment (a ratio <1 represents fatty liver). RESULTS: Intensive insulin alone and insulin + pioglitazone significantly improved glycaemic control (7.8 ± 0.3 to 7.2 ± 0.3% and 7.6 ± 0.3 to 7.1 ± 0.4%, respectively). Body weight gain was greater with insulin + pioglitazone (4.9 ± 4.5 kg) versus insulin therapy alone (1.7 ± 0.7 kg). SAT increased significantly with pioglitazone + insulin therapy (393.9 ± 48.5 to 443.2 ± 56.7 cm(2) , p < 0.01) compared to a non-significant increase with insulin therapy alone (412.9 ± 42.5 to 420.8 ± 43.8 cm(2) ). VAT decreased non-significantly in both groups (240.3 ± 41.7 to 223.8 ± 38.1 cm(2) with insulin + pioglitazone and 266.6 ± 27.4 to 250.5 ± 22.2 cm(2) with insulin therapy). LBM increased significantly by 1.92 ± 0.74 kg with insulin + pioglitazone treatment. The L/S attenuation ratio in the placebo + insulin group decreased from 1.08 ± 0.1 to 1.04 ± 0.1 (p = ns) and increased from 1.00 ± 0.1 to 1.08 ± 0.05 (p = 0.06) in the pioglitazone + insulin group. CONCLUSIONS: Intensification of insulin therapy in type 2 diabeticpatients causes modest weight gain and no change in body fat distribution, LBM or liver fat. In contrast, the addition of pioglitazone, at equivalent glycaemia, increases weight gain, fat mass and SAT; increases LBM and tends to decrease liver fat. These changes in fat distribution may contribute to the beneficial effects of pioglitazone, despite greater weight gain. Published 2011. This article is a US Government work and is in the public domain in the USA.
Authors: Lourdes Ibáñez; Abel López-Bermejo; Marta Díaz; Goya Enríquez; Luis Del Río; Francis De Zegher Journal: Gynecol Endocrinol Date: 2010-05-26 Impact factor: 2.260
Authors: T Nakamura; T Funahashi; S Yamashita; M Nishida; Y Nishida; M Takahashi; K Hotta; H Kuriyama; S Kihara; N Ohuchi; T Nishimura; B I Kishino; K Ishikawa; T Kawamoto; K Tokunaga; C Nakagawa; I Mineo; F Watanabe; S Tarui; Y Matsuzawa Journal: Diabetes Res Clin Pract Date: 2001-12 Impact factor: 5.602
Authors: Thanh-Binh Nguyen-Duy; Milton Z Nichaman; Timothy S Church; Steven N Blair; Robert Ross Journal: Am J Physiol Endocrinol Metab Date: 2003-01-28 Impact factor: 4.310
Authors: R Longo; C Ricci; F Masutti; R Vidimari; L S Crocé; L Bercich; C Tiribelli; L Dalla Palma Journal: Invest Radiol Date: 1993-04 Impact factor: 6.016
Authors: David E Kelley; Therese M McKolanis; Refaat A F Hegazi; Lewis H Kuller; Satish C Kalhan Journal: Am J Physiol Endocrinol Metab Date: 2003-10 Impact factor: 4.310
Authors: Jeremy S Paige; Gregory S Bernstein; Elhamy Heba; Eduardo A C Costa; Marilia Fereirra; Tanya Wolfson; Anthony C Gamst; Mark A Valasek; Grace Y Lin; Aiguo Han; John W Erdman; William D O'Brien; Michael P Andre; Rohit Loomba; Claude B Sirlin Journal: AJR Am J Roentgenol Date: 2017-03-07 Impact factor: 3.959
Authors: Daniel F Vatner; Sachin K Majumdar; Naoki Kumashiro; Max C Petersen; Yasmeen Rahimi; Arijeet K Gattu; Mitchell Bears; João-Paulo G Camporez; Gary W Cline; Michael J Jurczak; Varman T Samuel; Gerald I Shulman Journal: Proc Natl Acad Sci U S A Date: 2015-01-06 Impact factor: 11.205
Authors: Silvio E Inzucchi; Richard M Bergenstal; John B Buse; Michaela Diamant; Ele Ferrannini; Michael Nauck; Anne L Peters; Apostolos Tsapas; Richard Wender; David R Matthews Journal: Diabetologia Date: 2015-01-13 Impact factor: 10.122
Authors: Rimke C Vos; Mariëlle Jp van Avendonk; Hanneke Jansen; Alexander N Goudswaard; Maureen van den Donk; Kees Gorter; Anneloes Kerssen; Guy Ehm Rutten Journal: Cochrane Database Syst Rev Date: 2016-09-18