Effects of Pioglitazone Versus Glipizide on Body Fat Distribution, Body Water Content, and Hemodynamics in Type 2 Diabetes

  1. Ananda Basu, MD1,
  2. Michael D. Jensen, MD1,
  3. Frances McCann, PHD2,
  4. Debabrata Mukhopadhyay, PHD2,
  5. Michael J. Joyner, MD3 and
  6. Robert A. Rizza, MD1
  1. 1Division of Endocrinology and Metabolism, Mayo Clinic College of Medicine, Rochester, Minnesota
  2. 2Department of Biochemistry and Molecular Biology, Mayo Clinic College of Medicine, Rochester, Minnesota
  3. 3Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota
  1. Address correspondence and reprint requests to Ananda Basu, MD, Consultant, Division of Endocrinology and Metabolism, 200 First St., SW, Rochester, MN 55905. E-mail: basu.ananda{at}mayo.edu

Abstract

OBJECTIVE—Pioglitazone, a peroxisome proliferator–activated receptor agonist and glipizide, an insulin secretagogue, are commonly used to treat type 2 diabetes. Our study was designed to examine the effects of pioglitazone versus glipizide on body water, body composition, and hemodynamic parameters in the presence of comparable glycemic control between groups.

RESEARCH DESIGN AND METHODS—We studied 19 diabetic subjects randomly assigned to either 45 mg pioglitazone (n = 8) or 10 mg (median dose) glipizide (n = 11) for 12 weeks. Body water content was measured with deuterated water, body composition by dual-energy X-ray absorptiometry and computed tomography, and cardiac output and systemic vascular resistance by acetylene rebreathing technique both before and after therapy.

RESULTS—Pioglitazone increased (P < 0.001 from baseline) total body water (+2.4 ± 0.5 l) accounting for 75% of the total weight gain (+3.1 ± 2.0 kg) but did not alter vascular endothelial growth factor concentrations. Total abdominal (−32.2 ± 19 cm2) and visceral fat area (−16.1 ± 8 cm2) tended to decrease with pioglitazone but increased (P < 0.02 for differences between groups) with glipizide (+38.4 ± 17 cm2 abdominal; +19.1 ± 9 cm2 visceral). Pioglitazone tended to reduce (P = 0.05) diastolic (−8.4 ± 4 mmHg) and mean (−9.5 ± 5 mmHg; P = 0.08) blood pressure and reduced (P < 0.001) systemic vascular resistance (2,785 ± 336 vs. 2,227 ± 136 dynes/s per m2), while there were no differences in these parameters with glipizide. Neither therapy altered circulating catecholamine concentrations.

CONCLUSIONS—When pioglitazone and glipizide are given in doses sufficient to achieve equivalent glycemic control in people with type 2 diabetes, pioglitazone increases total body water, thereby accounting for the majority of weight gain, tended to decrease visceral and abdominal fat content and blood pressure, and reduces systemic vascular resistance.

Footnotes

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

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted December 3, 2005.
    • Received October 19, 2005.
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  1. doi: 10.2337/diacare.29.03.06.dc05-2004 Diabetes Care March 2006 vol. 29 no. 3 510-514
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