Acta Diabetologica

, Volume 54, Issue 6, pp 561–568 | Cite as

Renal function preservation with pioglitazone or with basal insulin as an add-on therapy for patients with type 2 diabetes mellitus

  • Yu-Hung Chang
  • Der-Wei Hwu
  • Dao-Ming Chang
  • Ling-Wang An
  • Chang-Hsun Hsieh
  • Yau-Jiunn Lee
Original Article
First Online:
Received:
Accepted:

Abstract

Aims

Clinical outcome may differ owing to the distinct pharmacological characteristics of insulin sensitizers and insulin. This study was performed to compare the metabolic and renal function changes with add-on pioglitazone treatment versus basal insulin in patients with type 2 diabetes mellitus (DM) in whom sulfonylurea and metformin regimens failed.

Methods

Patients who were consecutively managed in the diabetes comprehensive program with add-on pioglitazone or detemir/glargine treatment for at least 2 years following sulfonylurea and metformin treatment failure were included.

Results

A total of 1002 patients were enrolled (pioglitazone: 559, detemir: 264, glargine: 179). After propensity score matching, there were 105 patients with matchable baseline characteristics in each group. After a mean of 3.5 years of follow-up, the pioglitazone group showed a greater HbA1c reduction than the detemir group and the glargine group. Despite patients in all three groups exhibiting significant body weight gain, those in the pioglitazone group and the glargine group showed greater body weight increases than the patients in the detemir group (2.1, 1.6 and 0.8 kg, respectively, p < 0.05). Interestingly, Cox regression analysis indicated that patients under detemir or glargine treatment had a higher probability of CKD progression as compared with the pioglitazone group, with hazard ratios of 2.63 (95% CI 1.79–3.88) and 3.13 (95% CI 2.01–4.87), respectively.

Conclusions

Our study first showed that treatment with both pioglitazone and basal insulin improved glycemic control, while only pioglitazone treatment was observed to be advantageous in terms of preserving renal function when used as an add-on therapy for patients with type 2 DM in whom sulfonylurea and metformin regimens failed.

Keywords

Pioglitazone Basal insulin Renal function Type 2 diabetes mellitus 
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Notes

Acknowledgements

The authors thank Felix Thoemmes, Department of Human Development, Cornell University, Ithaca, NY, for the development of the propensity score matching program for SPSS.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Author contributions

YHC and DWH contributed to the acquisition, analysis, interpretation of the data and the development of the manuscript. DMC contributed to the acquisition and analysis of the data. ALW and CHH contributed to the discussion. YJL contributed to the discussion and reviewed/edited the manuscript.

Compliance with ethical standards

Conflicts of interest

Y.-H. Chang, D.-M. Chang and Y.-J. Lee received speaking fees from NovoNordisk and Sanofi.

Human and animal rights disclosure

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board of Tri-Service General Hospital and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Formal consent is not required for this retrospective study.

Data availability statements

The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.

Supplementary material

592_2017_983_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 22 kb)

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Copyright information

© Springer-Verlag Italia 2017

Authors and Affiliations

  1. 1.Department of Internal MedicineLee’s Endocrinology ClinicPingtungTaiwan
  2. 2.Graduate Institute of Clinical MedicineKaohsiung Medical UniversityKaohsiungTaiwan
  3. 3.Department of Medical EducationBeijing Ruijing Diabetes HospitalBeijingChina
  4. 4.Division of Endocrinology and Metabolism, Department of Internal MedicineNational Defense Medical CenterTri-Service General HospitalTaipeiTaiwan

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