News & Research

Effect of pioglitazone compared with glimepiride on carotid intima-media thickness in type 2 diabetes: a randomized trial, by T. Mazzone and colleagues. JAMA, published online ahead of print, November 13, 2006.

What is the problem and what is known about it so far?

People with type 2 diabetes are more likely to have a heart attack?and tend to have worse outcomes after a heart attack?than people without diabetes.

Some research suggests that a type of anti-diabetes drug known as a thiazolidinedione (TZD) may help protect the heart. TZDs may slow the development of cardiovascular disease (CVD, disease of the heart and blood vessels) and make heart attacks less likely.

Why did the researchers do this particular study?

Researchers wanted to see whether a TZD drug, pioglitazone (Actos, Takeda), affected the development of CVD.

Who was studied?

The study included 462 people who had recently been diagnosed with type 2 diabetes. Participants were between 45 and 65 years old, and had no serious CVD.

How was the study done?

Participants had a physical exam and blood drawn for lab tests. To assess CVD, researchers used ultrasound to measure the thickness of the arterial walls in the neck. Thickening of arteries is an early stage in the hardening of the arteries (atherosclerosis), which leads to heart attack and other CVD.

Half of the participants received pioglitazone, and the other half took glimepiride, a different anti-diabetes drug.

After 18 months of treatment, researchers again measured the thickness of the participants? neck arteries.

What did the researchers find?

The progress of artery thickening slowed in people who took pioglitazone, but continued to get worse in those who took glimepiride.

What were the limitations of the study?

About 30% of people who originally enrolled in the study dropped out, which could affect the results.

The differences observed between the two groups might be that glimepiride makes arterial thickening worse, not that pioglitazone makes it better. There was no control group of people who were untreated with either drug.

What are the implications of the study?

Pioglitazone may slow the development of hardening of the arteries in people with type 2 diabetes. More research is needed to see whether the drug reduces the likelihood of CVD, and whether other TZDs have the same effect.

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