Article 289
Authors
A. Esteghamati, R. Azizi, M. Ebadi, S. Noshad, M. Mousavizadeh, M. Afarideh, M. Nakhjavani
Affiliation
Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Key words ▶ pioglitazone ● ▶ metformin ● ▶ inflammation ● ▶ osteoprotegerin ● ▶ intercellular adhesion ● molecule ▶ adiponectin ●
Abstract
received 01.11.2014 first decision 29.11.2014 accepted 10.12.2014 Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1396864 Published online: January 21, 2015 Exp Clin Endocrinol Diabetes 2015; 123: 289–295 © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York ISSN 0947-7349 Correspondence A. Esteghamati, MD Professor of Endocrinology and Metabolism Endocrinology and Metabolism Research Center (EMRC) Vali-Asr Hospital Tehran University of Medical Sciences P.O. Box 13145-784 Tehran Iran Tel.: + 98/21/88417 918 Fax: + 98/21/64432 466 [email protected]
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Aim: The etiologic role of inflammatory pathways in the development of diabetic complications, especially cardiovascular events, has been established. The anti-inflammatory role of metformin and pioglitazone has been described; however, no study to date has compared the efficacy of these common oral agents in this regard. In this study, the authors aimed to compare the anti-inflammatory properties of pioglitazone and metformin, with respect to their effect on serum concentrations of highly sensitive C-reactive protein (hsCRP), osteoprotegerin (OPG), intercellular adhesion molecule-1 (ICAM-1) and adiponectin. Methods: In an open-label randomized clinical trial, 117 patients with newly diagnosed type 2 diabetes mellitus were visited; 84 fulfilled the inclusion criteria, and were randomly allocated to 2 arms receiving either 1 000 mg/d metformin or 30 mg/d pioglitazone, respectively. Biochemi-
Introduction
▼
Type 2 diabetes mellitus (T2DM) is among the most common chronic diseases worldwide, affecting more than four million people in our country [1]. Atherosclerosis, recognized as an inflammatory process, is the leading cause of morbidity and mortality in DM. The correlation between elevated inflammatory markers and cardiovascular disease (CVD) is well established [2]. Complex inflammatory pathways are involved in the development of DM. The role of various inflammatory markers such as C-reactive protein (CRP), osteoprotegerin (OPG) [3], intercellular adhesion molecule (ICAM) [4] and adiponectin in the development of T2DM has been studied comprehensively [3]. During the inflammatory process, ICAM is released by activated macrophages, T cells and smooth muscle cells,
cal assessments were made at baseline and the end of the 3 months trial. Results: Significant reduction in FPG, insulin and HbA1c in women and men of both arms were observed. Log-hsCRP values significantly decreased in both arms. A decreasing, but nonsignificant trend in log-OPG levels was observed in women of the metformin arm (p = 0.063). A greater reduction in log-ICAM levels was identifiable in men receiving pioglitazone compared to the other arm (p = 0.008); in addition, the same trend was observed in log-OPG values (p = 0.029). Nonetheless, reduction in log-ICAM and log-OPG levels was comparable between the 2 arms. A significant increase in adiponectin was observed in both men and women in the pioglitazone arm (p
Authors
A. Esteghamati, R. Azizi, M. Ebadi, S. Noshad, M. Mousavizadeh, M. Afarideh, M. Nakhjavani
Affiliation
Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Key words ▶ pioglitazone ● ▶ metformin ● ▶ inflammation ● ▶ osteoprotegerin ● ▶ intercellular adhesion ● molecule ▶ adiponectin ●
Abstract
received 01.11.2014 first decision 29.11.2014 accepted 10.12.2014 Bibliography DOI http://dx.doi.org/ 10.1055/s-0034-1396864 Published online: January 21, 2015 Exp Clin Endocrinol Diabetes 2015; 123: 289–295 © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York ISSN 0947-7349 Correspondence A. Esteghamati, MD Professor of Endocrinology and Metabolism Endocrinology and Metabolism Research Center (EMRC) Vali-Asr Hospital Tehran University of Medical Sciences P.O. Box 13145-784 Tehran Iran Tel.: + 98/21/88417 918 Fax: + 98/21/64432 466 [email protected]
▼
Aim: The etiologic role of inflammatory pathways in the development of diabetic complications, especially cardiovascular events, has been established. The anti-inflammatory role of metformin and pioglitazone has been described; however, no study to date has compared the efficacy of these common oral agents in this regard. In this study, the authors aimed to compare the anti-inflammatory properties of pioglitazone and metformin, with respect to their effect on serum concentrations of highly sensitive C-reactive protein (hsCRP), osteoprotegerin (OPG), intercellular adhesion molecule-1 (ICAM-1) and adiponectin. Methods: In an open-label randomized clinical trial, 117 patients with newly diagnosed type 2 diabetes mellitus were visited; 84 fulfilled the inclusion criteria, and were randomly allocated to 2 arms receiving either 1 000 mg/d metformin or 30 mg/d pioglitazone, respectively. Biochemi-
Introduction
▼
Type 2 diabetes mellitus (T2DM) is among the most common chronic diseases worldwide, affecting more than four million people in our country [1]. Atherosclerosis, recognized as an inflammatory process, is the leading cause of morbidity and mortality in DM. The correlation between elevated inflammatory markers and cardiovascular disease (CVD) is well established [2]. Complex inflammatory pathways are involved in the development of DM. The role of various inflammatory markers such as C-reactive protein (CRP), osteoprotegerin (OPG) [3], intercellular adhesion molecule (ICAM) [4] and adiponectin in the development of T2DM has been studied comprehensively [3]. During the inflammatory process, ICAM is released by activated macrophages, T cells and smooth muscle cells,
cal assessments were made at baseline and the end of the 3 months trial. Results: Significant reduction in FPG, insulin and HbA1c in women and men of both arms were observed. Log-hsCRP values significantly decreased in both arms. A decreasing, but nonsignificant trend in log-OPG levels was observed in women of the metformin arm (p = 0.063). A greater reduction in log-ICAM levels was identifiable in men receiving pioglitazone compared to the other arm (p = 0.008); in addition, the same trend was observed in log-OPG values (p = 0.029). Nonetheless, reduction in log-ICAM and log-OPG levels was comparable between the 2 arms. A significant increase in adiponectin was observed in both men and women in the pioglitazone arm (p
