A Comparison of Lipid and Glycemic Effects of Pioglitazone and Rosiglitazone in Patients With Type 2 Diabetes and Dyslipidemia

  1. Ronald B. Goldberg, MD1,
  2. David M. Kendall, MD2,
  3. Mark A. Deeg, MD, PHD3,
  4. John B. Buse, MD, PHD4,
  5. Anthony J. Zagar, MS5,
  6. Jane A. Pinaire, PHD5,
  7. Meng H. Tan, MD5,
  8. Mehmood A. Khan, MD6,
  9. Alfonso T. Perez, MD7,
  10. Scott J. Jacober, DO5 and
  11. for the GLAI Study Investigators
  1. 1Division of Endocrinology, Metabolism, and Diabetes, University of Miami School of Medicine, Miami, Florida
  2. 2International Diabetes Center, Park Nicollet Institute, Minneapolis, Minnesota
  3. 3Division of Endocrinology and Metabolism, Department of Veterans Affairs and the Indiana University School of Medicine, Indianapolis, Indiana
  4. 4Divisions of Endocrinology and of General Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
  5. 5Lilly Research Laboratories, Eli Lilly, Indianapolis, Indiana
  6. 6Takeda Pharmaceuticals North America, Lincolnshire, Illinois
  7. 7Takeda Global Research and Development Center, Lincolnshire, Illinois
  1. Address correspondence and reprint requests to Scott J. Jacober, DO, Lilly Research Laboratories, A Division of Eli Lilly, Lilly Corporate Center, DC 5116, Indianapolis, IN 46285. E-mail: sjacober{at}lilly.com

Abstract

OBJECTIVE—Published reports suggest that pioglitazone and rosiglitazone have different effects on lipids in patients with type 2 diabetes. However, these previous studies were either retrospective chart reviews or clinical trials not rigorously controlled for concomitant glucose- and lipid-lowering therapies. This study examines the lipid and glycemic effects of pioglitazone and rosiglitazone.

RESEARCH DESIGN AND METHODS—We enrolled subjects with a diagnosis of type 2 diabetes (treated with diet alone or oral monotherapy) and dyslipidemia (not treated with any lipid-lowering agents). After a 4-week placebo washout period, subjects randomly assigned to the pioglitazone arm (n = 400) were treated with 30 mg once daily for 12 weeks followed by 45 mg once daily for an additional 12 weeks, whereas subjects randomly assigned to rosiglitazone (n = 402) were treated with 4 mg once daily followed by 4 mg twice daily for the same intervals.

RESULTS—Triglyceride levels were reduced by 51.9 ± 7.8 mg/dl with pioglitazone, but were increased by 13.1 ± 7.8 mg/dl with rosiglitazone (P < 0.001 between treatments). Additionally, the increase in HDL cholesterol was greater (5.2 ± 0.5 vs. 2.4 ± 0.5 mg/dl; P < 0.001) and the increase in LDL cholesterol was less (12.3 ± 1.6 vs. 21.3 ± 1.6 mg/dl; P < 0.001) for pioglitazone compared with rosiglitazone, respectively. LDL particle concentration was reduced with pioglitazone and increased with rosiglitazone (P < 0.001). LDL particle size increased more with pioglitazone (P = 0.005).

CONCLUSIONS—Pioglitazone and rosiglitazone have significantly different effects on plasma lipids independent of glycemic control or concomitant lipid-lowering or other antihyperglycemic therapy. Pioglitazone compared with rosiglitazone is associated with significant improvements in triglycerides, HDL cholesterol, LDL particle concentration, and LDL particle size.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted March 31, 2005.
    • Received February 10, 2005.
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  1. doi: 10.2337/diacare.28.7.1547 Diabetes Care July 2005 vol. 28 no. 7 1547-1554
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