제2형 당뇨병환자에서 장기간의 피오글리타존 투여에 따른 임상적 관찰

Abstract

Background: Type 2 diabetes is characterized by impaired insulin secretion and/or insulin resistance. Thiazolidinediones have been shown to ameliorate insulin resistance. The purpose of the present study was to evaluate the long term serial effect of pioglitazone on anthropometrics and metabolic parameters in Korean type 2 diabetes patients. Methods: One hundred thirteen type 2 diabetes patients (male, 67; female, 46; mean age, 49.1 ± 10.8 years) were evaluated before and after 3 months, 6 months and 12 months of treatment with pioglitazone (Actos(TM), 15 mg/day). Anthropometric parameters and metabolic variables were measured. Results: Body weight and body mass index (BMI) were increased in 3 months after pioglitazone treatment (body weight, 68.8 ± 12.2 vs 69.8 ± 11.9 kg, P < 0.01) without further increase. In women, body weight and BMI tended to increase more (body weight change after 3 months, 0.6 ± 1.7 kg vs 1.6 ± 1.7 kg, P < 0.01) and longer (3 months vs 6 months) than in men. Fasting plasma glucose (FPG) and HbA1c were decreased in 3 months after pioglitazone treatment (FPG, 7.97 ± 2.29 vs 6.94 ± 2.01 mmol/L, P < 0.01; HbA1c, 7.7 ± 1.5 vs 7.0 ± 1.1%, P < 0.01). Hypoglycemic effect of pioglitazone was prominent in women than in men (FPG change after 12 months, -1.80 ± 2.54 vs -0.09 ± 1.72 mmol/L, P < 0.001; HbA1c change after 12 months, -0.9 ± 1.3 vs -0.4 ± 1.1%, P < 0.05). Serum high-density lipoprotein cholesterol was increased after 3 months of pioglitazone treatment (1.16 ± 0.24 vs 1.31 ± 0.28 mmol/L, P < 0.01) without return until the end of this study. Serum triglycerides level decreased at 3 months (basal vs 3 months, 2.29 ± 1.86 vs 1.88 ± 1.21 mmol/L, P < 0.01) and 6 months (basal vs 6 months, 2.29 ± 1.86 vs 1.97 ± 1.40 mmol/L, P< 0.05) of pioglitazone treatment, but returned to basal level at 12 months. Liver enzyme, especially serum alanine transferase level decreased after 3 months of pioglitazone treatment (30.8 ± 23.7 vs 24.5 ± 18.5 IU/L, P < 0.01) without return until the end of this study. Hypoglycemic effect of pioglitazone was associated with basal BMI, fat contents and serum leptin level. Conclusion: Korean type 2 diabetes patients with pioglitazone use showed favorable metabolic effect for glycemic control, lipid metabolism and liverfunction, but pioglitazone induced body weight increase may be limited.