Effects of intensive insulin therapy alone and in combination with pioglitazone on body weight, composition, distribution and liver fat content in patients with type 2 diabetes.

摘要

AIM: To evaluate the effects of intensive insulin therapy alone and with added pioglitazone on body weight, fat distribution, lean body mass (LBM) and liver fat in type 2 diabetic patients. METHODS: Twenty-five insulin-treated, obese patients with type 2 diabetes were randomized to addition of pioglitazone 45 mg (n = 12) or placebo (n = 13) and treated intensively for 12-16 weeks. Dual-energy X-ray absorptiometry/abdominal computed tomography scans were performed before/after treatment. LBM, visceral/subcutaneous adipose tissue (VAT/SAT) and liver/spleen (L/S) attenuation ratios were measured pre-/posttreatment (a ratio <1 represents fatty liver). RESULTS: Intensive insulin alone and insulin + pioglitazone significantly improved glycaemic control (7.8 +/- 0.3 to 7.2 +/- 0.3% and 7.6 +/- 0.3 to 7.1 +/- 0.4%, respectively). Body weight gain was greater with insulin + pioglitazone (4.9 +/- 4.5 kg) versus insulin therapy alone (1.7 +/- 0.7 kg). SAT increased significantly with pioglitazone + insulin therapy (393.9 +/- 48.5 to 443.2 +/- 56.7 cm(2) , p < 0.01) compared to a non-significant increase with insulin therapy alone (412.9 +/- 42.5 to 420.8 +/- 43.8 cm(2) ). VAT decreased non-significantly in both groups (240.3 +/- 41.7 to 223.8 +/- 38.1 cm(2) with insulin + pioglitazone and 266.6 +/- 27.4 to 250.5 +/- 22.2 cm(2) with insulin therapy). LBM increased significantly by 1.92 +/- 0.74 kg with insulin + pioglitazone treatment. The L/S attenuation ratio in the placebo + insulin group decreased from 1.08 +/- 0.1 to 1.04 +/- 0.1 (p = ns) and increased from 1.00 +/- 0.1 to 1.08 +/- 0.05 (p = 0.06) in the pioglitazone + insulin group. CONCLUSIONS: Intensification of insulin therapy in type 2 diabetic patients causes modest weight gain and no change in body fat distribution, LBM or liver fat. In contrast, the addition of pioglitazone, at equivalent glycaemia, increases weight gain, fat mass and SAT; increases LBM and tends to decrease liver fat. These changes in fat distribution may contribute to the beneficial effects of pioglitazone, despite greater weight gain.