By: Daniel Trecroci
Actos, an insulin sensitizer in the glitazone class of type 2 oral diabetes medications, was found to reduce carotid artery intima-media thickness (IMT) as well as insulin resistance in a German study.
Study participants were randomized to receive either Actos (pioglitazone) or Amaryl (glimepiride), an insulin secretagogue in the sulfonylurea class of type 2 oral diabetes medications, for 12 and 24 weeks. The study population consisted of 66 females and 107 males with an average age of 62.6 years, average BMI of 31.8 and average A1C of 7.5%.
After 24 weeks, only the Actos group saw reductions in carotid IMT. After 12 weeks, thickness decreased an average of 0.033 millimeters, and after 24 weeks the decrease reached an average of 0.054 millimeters. In addition, insulin resistance was significantly improved in the Actos group versus the Amaryl group.
Both groups had similar improvement in A1C levels.
—Circulation, May 17, 2005
Why is this study important to people with type 2 diabetes?
This study proves that lowering of glucose alone is not enough to reduce the risk for myocardial infarction. Type 2 diabetes is a very complex disease, and blood glucose deterioration is only one half of it. The lack of insulin effects at the inner layer of the blood vessels (that have nothing to do with glucose lowering) leads to this increased cardiovascular risk. To restore these effects, the treatment should focus on a reduction of insulin resistance. Basically this can be achieved by diet and exercise, but our study shows that Actos is a very potent drug not only in terms of glucose lowering but also in improving the situation in the blood vessels.
What else can type 2s do to improve their IMT?
Regular exercise and maintenance of a normal body weight is the best and cheapest way to reduce IMT. Next to Actos, the lipid-lowering drug class of statins has been shown to also have a beneficial effect on IMT. Preliminary results from a currently running study at our institute indicate that the combination of Actos with a statin shows a synergistic effect on cardiovascular risk markers, i.e., the combination seems to be better than the single drugs in this respect.
Andreas Pfützner, MD, PhD, of the Institute of Clinical Research and Development in Mainz, Germany, was a researcher on the Actos study.
‘Carotid Intima-Media Thickness’ refers to the inner lining of the neck arteries. This measurement is an indicator for cardiovascular risk, because that area is where cholesterol plaque accumulates. A thickened carotid intima-media layer correlates not only with the presence of cardiovascular risk factors but also with the risk of future cardiovascular events such as heart attack and stroke. For people with type 2 diabetes, the risk of cardiovascular disease is two to four times that of the general population.
Source: Institute for Clinical Research and Development