Abstract
New scores and biochemical markers have recently been published for diagnosis of insulin
resistance and β-cell dysfunction (such as intact proinsulin, adiponectin, IRISII-score).
One goal of this 6-month prospective controlled study was to evaluate the impact of
pioglitazone (45 mg) vs. glimepiride (1-6 mg, in the intend to optimize therapy) on these markers. Observation
parameters were: IRIS-II score, HOMA-score, ATP III score, HbA1c , fasting glucose, lipids, intact proinsulin, adiponectin, and adverse events. The
study was completed by 173 patients (66 female, 107 male, age ± STD: 63 ± 8 years,
disease duration: 7.2 ± 7.2 years, HbA1c : 7.53 ± 0.85 %, pioglitazone arm: 89 patients). The groups were not different for
any of the observation parameters at baseline, and a similar reduction in HbA1c was seen in both groups (p < 0.001). In the pioglitazone group, reductions were observed
for the IRIS-II and HOMA scores (p < 0.001 vs. glimepiride at endpoint) fasting glucose (p < 0.001), insulin (p < 0.001), LDL/HDL
ratio (p < 0.001), hsCRP (p < 0.05), intact proinsulin (p < 0.001), and an increase
was seen in HDL (p < 0.001), adiponectin (p < 0.001) and BMI (p < 0.001). In conclusion,
treatment with pioglitazone resulted in an improvement of markers for insulin resistance
and β-cell dysfunction, independent from blood glucose control. Adiponectin, intact
proinsulin, and the IRIS-II score may be suitable parameters for monitoring of these
additional beneficial therapeutic effects.
Key words
Intact proinsulin · Adiponectin · IRIS-II score · HOMA score
AndreasP@ikfe.de
