Effects of bed-time insulin versus pioglitazone on abdominal fat accumulation, inflammation and gene expression in adipose tissue in patients with type 2 diabetes

Diabetes Res Clin Pract. 2009 Oct;86(1):37-43. doi: 10.1016/j.diabres.2009.06.028. Epub 2009 Aug 15.


Aims/hypothesis: Intra-abdominal fat (IAF) and inflammatory markers are correlated with cardio-vascular risk. We compared the impact of bed-time insulin versus pioglitazone treatment on these parameters in type 2 diabetic (T2D) patients.

Methods: Twenty-eight T2D patients poorly controlled with metformin and sulfonylurea were randomized to receive add-on therapy with pioglitazone or bed-time NPH insulin. IAF and subcutaneous fat (SCF) content, systemic low-grade inflammation level and expression of inflammation related genes in SCF, were measured before and after 24 weeks of treatment.

Results: Insulin and pioglitazone resulted in a significant decrease in HbA1c (-1.6% and -1.2%, respectively) and a significant increase in total body fat mass (1+/-2.3 and 3.3+/-2.7 kg, respectively). There was no change in IAF content after both treatments whereas significant increase in SCF content was only seen after pioglitazone treatment (p<0.05 versus insulin). hsCRP level decreased after pioglitazone and ferritin level decreased after insulin treatment. No change in mRNA expression of inflammation related genes was found after either treatment.

Conclusion/interpretation: This suggests that a 24-week treatment with pioglitazone or bed-time insulin has a similar impact on intra-abdominal fat mass and systemic low-grade inflammation.

Trial registration: ClinicalTrials.gov NCT00159211.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adipose Tissue / drug effects*
  • Adipose Tissue / metabolism
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antigens, CD / genetics
  • Antigens, Differentiation, Myelomonocytic / genetics
  • Body Composition / drug effects
  • Body Weight / drug effects
  • Chemokine CCL2 / genetics
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / therapy*
  • Female
  • Humans
  • Hypoglycemic Agents* / pharmacology
  • Hypoglycemic Agents* / therapeutic use
  • Inflammation / drug therapy*
  • Insulin* / pharmacology
  • Insulin* / therapeutic use
  • Interleukin-6 / genetics
  • Intra-Abdominal Fat / drug effects*
  • Male
  • Metformin* / pharmacology
  • Metformin* / therapeutic use
  • Middle Aged
  • Reverse Transcriptase Polymerase Chain Reaction
  • Young Adult


  • Antigens, CD
  • Antigens, Differentiation, Myelomonocytic
  • CCL2 protein, human
  • CD68 antigen, human
  • Chemokine CCL2
  • Hypoglycemic Agents
  • Insulin
  • Interleukin-6
  • Metformin

Associated data

  • ClinicalTrials.gov/NCT00159211