Patients with type 2 diabetes mellitus are at high risk of cardiovascular disease. Carotid intima-media thickness(IMT) is a strong predictor of myocardial infarction and stroke. Methods and Results-We compared the eff...Patients with type 2 diabetes mellitus are at high risk of cardiovascular disease. Carotid intima-media thickness(IMT) is a strong predictor of myocardial infarction and stroke. Methods and Results-We compared the effects of pioglitazone-based therapy(45 mg/d) and glimepiride-based treatment(2.7± 1.6 mg/d) for 12 and 24 weeks on metabolic control(HbA1c), insulin resistance(homeostasis model assessment), and carotid IMT(B-mode ultrasonography) in a randomized controlled study in 173 orally treated patients with type 2 diabetes(66 women, 107 men; mean± SD age, 62.6± 7.9 years; body mass index, 31.8± 4.6 kg/m2; HbA1c, 7.5± 0.9% ). Treatment was generally well tolerated in both groups. Despite similar improvements in metabolic control(HbA 1c) after 24 weeks(- 0.8± 0.9% [pioglitazone] versus - 0.6± 0.8% [glimepiride]; P=NS), carotid IMT was reduced only in the pioglitazone group after 12 weeks(- 0.033± 0.052 versus- 0.002± 0.047mm[glimepiride]; P< 0.01 between groups) and 24 weeks(- 0.054± 0.059 versus - 0.011± 0.058 mm[glimepiride]; P< 0.005 between groups). Insulin resistance was also improved only in the pioglitazone group(homeostasis model assessment,- 2.2± 3.4 versus- 0.3± 3.3; P< 0.0001 between groups). Reduction of IMT correlated with improvement in insulin resistance(r=0.29, P< 0.0005) and was independent of improvement in glycemic control(r=0.03, P=0.68). Conclusions-We found a substantial regression of carotid IMT, independent of improved glycemic control, after 12 and 24 weeks of pioglitazone treatment. This finding may have important prognostic implications for patients with type 2 diabetes mellitus.展开更多
文摘Patients with type 2 diabetes mellitus are at high risk of cardiovascular disease. Carotid intima-media thickness(IMT) is a strong predictor of myocardial infarction and stroke. Methods and Results-We compared the effects of pioglitazone-based therapy(45 mg/d) and glimepiride-based treatment(2.7± 1.6 mg/d) for 12 and 24 weeks on metabolic control(HbA1c), insulin resistance(homeostasis model assessment), and carotid IMT(B-mode ultrasonography) in a randomized controlled study in 173 orally treated patients with type 2 diabetes(66 women, 107 men; mean± SD age, 62.6± 7.9 years; body mass index, 31.8± 4.6 kg/m2; HbA1c, 7.5± 0.9% ). Treatment was generally well tolerated in both groups. Despite similar improvements in metabolic control(HbA 1c) after 24 weeks(- 0.8± 0.9% [pioglitazone] versus - 0.6± 0.8% [glimepiride]; P=NS), carotid IMT was reduced only in the pioglitazone group after 12 weeks(- 0.033± 0.052 versus- 0.002± 0.047mm[glimepiride]; P< 0.01 between groups) and 24 weeks(- 0.054± 0.059 versus - 0.011± 0.058 mm[glimepiride]; P< 0.005 between groups). Insulin resistance was also improved only in the pioglitazone group(homeostasis model assessment,- 2.2± 3.4 versus- 0.3± 3.3; P< 0.0001 between groups). Reduction of IMT correlated with improvement in insulin resistance(r=0.29, P< 0.0005) and was independent of improvement in glycemic control(r=0.03, P=0.68). Conclusions-We found a substantial regression of carotid IMT, independent of improved glycemic control, after 12 and 24 weeks of pioglitazone treatment. This finding may have important prognostic implications for patients with type 2 diabetes mellitus.
