Biomedical Center, Tokyo, Japan.
Division of Diabetes and Endocrinology, Department of Internal Medicine, Gyoda General Hospital, Saitama, Japan.
Int J Clin Pract. 2021 Dec;75(12):e14914. doi: 10.1111/ijcp.14914. Epub 2021 Oct 28.
The aim of this study was to investigate the differential regulation of metabolic parameters between pioglitazone and canagliflozin in relation to their glycaemic efficacies.
Drug-naive subjects with T2DM received pioglitazone 15-30 mg/day or canagliflozin 50-100 mg/day monotherapy for 3 months. Those who had a ≥1% reduction in HbA1c were defined as responders and others who had a <1% reduction were defined as non-responders.
In the pioglitazone group, baseline BMI, FFA, HOMA-R or adipo-IR was significantly higher, and HDL-C was significantly lower in responders vs non-responders. In the canagliflozin group, baseline HbA1c or FBG was significantly higher, and HOMA-B or age was significantly lower in responders vs non-responders. In pioglitazone responders, significant decreases in HbA1c (from 10.75% to 8.31%), FBG (-29.7%), FFA (-37.7%), non-HDL-C (-13.4%), TG (-30.1%), HOMA-R (-35.6%) or adipo-IR (-38.7%), and increases in BMI (2.8%) or HDL-C (14.2%) were observed. In pioglitazone non-responders, none of the parameters were regulated. In canagliflozin responders, significant decreases in HbA1c (from 11.31% to 8.60%), FBG (32.1%), BMI (-2%) or HOMA-R (-33.8%), and increases in HOMA-B (50%) were observed. In canagliflozin non-responders, significant decreases in BMI (-2.4%), insulin (-21.8%) or HOMA-R (-33.6%) were observed.
(i) Glycaemic efficacy of pioglitazone is linked to body weight and atherogenic lipids while this is not the case with canagliflozin. (ii) Responders (or non-responders) to pioglitazone have some distinct features from non-responders (or responders) to canagliflozin. Collectively, a combination of pioglitazone and canagliflozin may compensate for each other's metabolic drawbacks or augment their advantages, thereby achieving overall improvements in the metabolic profiles and pathogenic defects of patients with T2DM.
本研究旨在探讨吡格列酮和卡格列净在血糖疗效方面的差异调节与代谢参数之间的关系。
新诊断的 2 型糖尿病患者接受吡格列酮 15-30mg/天或卡格列净 50-100mg/天单药治疗 3 个月。HbA1c 降低≥1%的患者定义为应答者，HbA1c 降低<1%的患者定义为无应答者。
在吡格列酮组中，应答者的基线 BMI、FFA、HOMA-R 或 adiponectin-IR 显著较高，而 HDL-C 显著较低。在卡格列净组中，应答者的基线 HbA1c 或 FBG 显著较高，而 HOMA-B 或年龄显著较低。在吡格列酮应答者中，HbA1c（从 10.75%降至 8.31%）、FBG（-29.7%）、FFA（-37.7%）、非 HDL-C（-13.4%）、TG（-30.1%）、HOMA-R（-35.6%）或 adiponectin-IR（-38.7%）显著降低，BMI（2.8%）或 HDL-C（14.2%）显著增加。在吡格列酮无应答者中，没有任何参数得到调节。在卡格列净应答者中，HbA1c（从 11.31%降至 8.60%）、FBG（32.1%）、BMI（-2%）或 HOMA-R（-33.8%）显著降低，而 HOMA-B（50%）显著增加。在卡格列净无应答者中，BMI（-2.4%）、胰岛素（-21.8%）或 HOMA-R（-33.6%）显著降低。
（i）吡格列酮的降糖疗效与体重和致动脉粥样硬化脂质有关，而卡格列净则不然。（ii）吡格列酮的应答者（或无应答者）与卡格列净的应答者（或无应答者）有一些不同的特征。总之，吡格列酮和卡格列净的联合使用可能会相互弥补各自的代谢缺陷或增强各自的优势，从而全面改善 2 型糖尿病患者的代谢谱和致病缺陷。
