Pioglitazone in addition to metformin improves erythrocyte deformability in patients with type 2 diabetes mellitus.
Résumé
The aim of this study was to compare the effect of pioglitazone or glimepiride on erythrocyte deformability in T2DM. The study covered 23 metformin treated T2DM patients with an HbA1c above 6.5%. Patients were randomized to receive either 15 mg Pioglitazone (PIO) bid. or 1 mg Glimepiride (GLIM) bid. in combination with 850 mg Metformin bid. for 6 months. Blood samples were taken for the measurement of fasting glucose, HbA1c, fasting insulin, intact proinsulin, adiponectin, and heamatocrit (Hct). In addition, the erythrocyte elongation index (EI) was measured using laserdiffractoscopy. Both treatments significantly improved HbA1c levels (PIO -0.9 ± 1.1%; GLIM -0.6 ± 0.4%; p<0.05 respectively) and end up in comparable HbA1c levels after 6 months (PIO 6.5 ± 1.2; GLIM 6.2 ± 0.4) Treatment with PIO reduced fasting insulin levels (-8.7 ± 15.8 mU/L; p=0.098), intact proinsulin levels (-11.8 ± 9.5 pmol/L; p<0.05), and Hct (-1.3 ± 2.3%; p=0.09), while adiponectin levels increased (8.2 ± 4.9 µg/mL; p<0.05). No significant change in these parameters could be observed during GLIM treatment. PIO improved the EI, resulting in a significant increase in EI at all physiological shear stress ranges (0.6 to 6.0 Pa; p<0.05). The improvement in EI correlated with the increase in adiponectin levels (r=0.74; p<0.001), and inversely with intact proinsulin levels (r=-0.47; p<0.05). This is the first study showing an improvement in EI during treatment with pioglitazone, which was associated with an increase in adiponectin and a decrease in intact proinsulin levels.
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