The Insulin Sensitiser Pioglitazone Does Not Influence Skin Microcirculatory Function in Patients with Type 2 Diabetes Treated with Insulin.
From: Institute of Biomedical and Clinical Science, Peninsula Medical School, Barrack Road, Exeter, EX2 5AX, UK. john.tooke@pms.ac.uk
Diabetologia
- Publish Date: May 2006
- ISSN: 0012-186X
- Volume: 49
- Issue: 5
- Pages: 1064-70
- Medium: Print
- Language: English
- Citation (JAMA): Tooke J E, Elston L M, Gooding K M, et al. The Insulin Sensitiser Pioglitazone Does Not Influence Skin Microcirculatory Function in Patients with Type 2 Diabetes Treated with Insulin.. Diabetologia May 2006;49:1064-70
Abstract
AIMS/HYPOTHESIS: Insulin resistance is associated with abnormal microvascular function. Treatment with insulin sensitisers may provoke oedema, suggesting microvascular effects. The mechanisms underlying the peripheral oedema observed during glucose-lowering treatment with thiazolidinediones are unclear. Therefore we examined the effect of pioglitazone on microvascular variables involved in oedema formation. METHODS: Subjects (40-80 years) with type 2 diabetes and on insulin were randomised to 9 weeks of pioglitazone therapy (30 mg/day; n=14) or placebo (n=15). The following assessments were performed at baseline and 9 weeks: microvascular filtration capacity; isovolumetric venous pressure; capillary pressure; capillary recruitment following venous or arterial occlusion; postural vasoconstriction; and maximum blood flow. A number of haematological variables were also measured including vascular endothelium growth factor (VEGF), IL-6 and C-reactive protein (CRP). RESULTS: Pioglitazone did not significantly influence any microcirculatory variable as compared with placebo (analysis of covariance [ANCOVA] for microvascular filtration capacity for the two groups, p=0.26). Mean VEGF increased with pioglitazone (61.1 pg/ml), but not significantly more than placebo (9.76 pg/ml, p=0.94). HbA(1c) levels and the inflammatory markers IL-6 and CRP decreased with pioglitazone compared with placebo (ANCOVA: p=0.009, p=0.001 and p=0.004, respectively). CONCLUSIONS/INTERPRETATION: Pioglitazone improved glycaemic control and inflammatory markers over 9 weeks but had no effect on microcirculatory variables associated with oedema or insulin resistance in type 2 diabetic patients treated with insulin.
Mesh Headings (Keywords): Adult, Aged, Aged, 80 and over, Blood Glucose, Blood Pressure, Body Mass Index, Diabetes Mellitus, Type 2, Double-Blind Method, Female, Hemoglobin A, Glycosylated, Humans, Hypoglycemic Agents, Insulin, Male, Microcirculation, Middle Aged, Placebos, Thiazolidinediones
Check for Full Text / PubMed Unique Identifier (PMID): 16508777
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