Pioglitazone has anti-inflammatory effects in patients with type 2 diabetes

"Background: Type 2 diabetes is characterized by increased acute phase serum proteins. They are also risk factors for cardiovascular disease. We wanted to study how improvement of glycemic control with pioglitazone or glibenclamide affects their serum concentrations. Materials and Methods: A total of 59 patients with Type 2 diabetes (age 57.3 +/- 1.2 yr, glycosylated hemoglobin (HbA(1c)) 8.3 +/- 0.7%, body mass index (BMI) 31.4 +/- 0.8 kg/m(2)) participated in the study. They were previously treated either with diet alone or in combination with one oral antihyperglycemic medicine. After a 1-week lead-in period on diet only, the patients were randomized to pioglitazone or glibenclamide. Blood samples for alpha-1-acid glycoprotein (A1GP), Creactive protein (CRP) and serum amyloid A (SAA) were taken before the treatments and during the therapy after 20 and 52 weeks. Results: Baseline Al GP correlated with CRP (r=0.70, p<0.001) and fasting glucose (r=0.32, p<0.02). Baseline CIRP correlated with HbAlc (r=0.26, p<0.05) and insulin (r=0.37, p<0.01). The anti-hyperglycemic effect was comparable with HbAlc levels decreasing both in the pioglitazone (from 8.18 +/- 0.09% to 7.63 +/- 0.17%, p<0.01) and glibenclamide (from 8.35 +/- 0.12% to 7.77 0.16%, p<0.01) groups. Pioglitazone treatment was associated with a reduction in Al GP at 20 weeks (p<0.001) and at 52 weeks (p<0.05) as compared to baseline. The significance remained also after comparison to glibenclamide therapy (p<0.001 and p<0.05, 20 and 52 weeks respectively). CIRP was also more reduced in the pioglitazone group at 20 weeks of treatment (p<0.05). Conclusions: Inflammatory factors and markers of hyperglycemia are associated in patients with Type 2 diabetes. Pioglitazone treatment results in reduced Al GP concentration suggesting an anti-inflammatory effect."