Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-chou, Itabashi-ku, Tokyo 173-8610, Japan.
Expert Opin Pharmacother. 2010 Jul;11(10):1611-20. doi: 10.1517/14656566.2010.495119.
We aimed to assess the effect of long-term pioglitazone treatment on erythropoietin responsiveness and insulin resistance in type 2 diabetic patients on hemodialysis.
We conducted a prospective, open-label, parallel-group, controlled study of 63 type 2 diabetic hemodialysis patients who were randomly assigned to two groups: pioglitazone group (P-group; 15-30 mg/day pioglitazone plus conventional oral hypoglycemic agents) and control group (C-group; conventional oral hypoglycemic agents alone). We determined the efficacy of pioglitazone by monitoring anemia, glycemic control, insulin resistance, and levels of inflammatory cytokines and high-molecular-weight (HMW) adiponectin for 96 weeks.
Pioglitazone effectively reduced erythropoietin dose and maintained the target hemoglobin levels by improving insulin resistance up to the end of the study. In the P-group, hemoglobin A(1c), glycated albumin, and triglycerides significantly decreased compared with the C-group. There was a significant reduction in homeostasis model assessment for insulin resistance and the level of high-sensitivity C-reactive protein, and a significant increase in HMW adiponectin level in the P-group; these changes were significantly different compared with values for the C-group. No serious adverse effects such as hypoglycemia, liver impairment, or heart failure were observed in any of the patients.
Pioglitazone treatment resulted in better glycemic control, improved lipid levels, an increase in insulin sensitivity and adiponectin levels, and a decrease in inflammatory markers, thus improving the risk factors of cardiovascular disease. Erythropoietin responsiveness improved with a reduction in erythropoietin dose and may be associated with the improvement in insulin resistance due to long-term pioglitazone treatment.
我们旨在评估长期吡格列酮治疗对接受血液透析的 2 型糖尿病患者促红细胞生成素反应性和胰岛素抵抗的影响。
我们进行了一项前瞻性、开放标签、平行组、对照研究，纳入了 63 名 2 型糖尿病血液透析患者，他们被随机分为两组：吡格列酮组（P 组；15-30mg/天吡格列酮加常规口服降糖药）和对照组（C 组；仅用常规口服降糖药）。我们通过监测贫血、血糖控制、胰岛素抵抗以及炎症细胞因子和高分子量（HMW）脂联素水平，在 96 周内确定吡格列酮的疗效。
吡格列酮通过改善胰岛素抵抗，有效地减少了促红细胞生成素的剂量，并维持了目标血红蛋白水平，直至研究结束。与 C 组相比，P 组的血红蛋白 A1c、糖化白蛋白和甘油三酯显著降低。与 C 组相比，P 组的稳态模型评估的胰岛素抵抗和高敏 C 反应蛋白水平显著降低，HMW 脂联素水平显著升高；这些变化与 C 组的值有显著差异。在任何患者中均未观察到严重的不良反应，如低血糖、肝损伤或心力衰竭。
吡格列酮治疗导致更好的血糖控制、改善血脂水平、增加胰岛素敏感性和脂联素水平、降低炎症标志物，从而改善心血管疾病的危险因素。促红细胞生成素反应性的改善与促红细胞生成素剂量的减少有关，这可能与长期吡格列酮治疗改善胰岛素抵抗有关。
