The Influences of Withdrawal and Daily Dose Reduction of Pioglitazone on Metabolic Parameters in Patients With Type 2 Diabetes: A Retrospective Longitudinal Observational Study

The Low-Dose (7.5 mg/day) Pioglitazone Therapy

Pioglitazone is one of thiazolidinedione derivatives, which stimulates nuclear peroxisome proliferator-activated receptor gamma and improves glucose and lipid metabolism and insulin sensitivity. A recent systematic review and meta-analysis showed that pioglitazone therapy was associated with a lower risk of major adverse cardiovascular events in patients with pre-diabetes and diabetes. Further, in a cohort study of patients with type 2 diabetes, pioglitazone therapy was associated with a statistically significant decrease in the risk of all-cause mortality. Despite these beneficial effects, the meta-analysis showed that pioglitazone therapy had higher risks of heart failure, bone fractures, edema and weight gain. To find out the efficacy and safety of the low-dose (7.5 mg/day) pioglitazone therapy, we reviewed the dose-response of pioglitazone on favorable effects and adverse effects due to pioglitazone, by searching the reports on effects of daily dose of 7.5 mg and/or 15 mg and/or 30 mg of pioglitazone. The low-dose pioglitazone therapy may show the same degree of improvements in glucose and lipid metabolism, fatty liver, insulin resistance, and adiponectin as the standard- and high-dose pioglitazone therapy. Furthermore, the low-dose pioglitazone therapy may also show less adverse effects on weight gain, edema and heart failure as compared with the standard- and high-dose pioglitazone therapy.

Influence of nutritional intervention on children with type 1 diabetes mellitus and DPP-4 in serum

The level of dipeptidyl peptidase-4 (DPP-4) of children with type 1 diabetes mellitus (T1DM) was observed to evaluate the improvement in function of the nutritional intervention. In total, 132 children with T1DM (T1DM group) and 132 healthy children (NC group) based on physical examination admitted to our hospital from September 2014 to June 2015 and were studied. General data of the two groups as well as the concentration of DPP-4 and various biochemical criterion in peripheral serum were collected and analyzed. Compared with NC group, DPP-4 level of T1DM group was obviously increased (P<0.05); after insulin treatment, the serum level of DPP-4 of T1DM group decreased, but was still significantly higher than that of NC group (P<0.05). After 3 months of clinical nutritional intervention, body mass index (BMI) of children with T1DM was significantly reduced compared with data before the treatment (P<0.05). However, the level of DPP-4 appeared unchanged (P>0.05). Pearson's correlation analysis showed that the level of DPP-4 had a positive correlation with diabetic duration, BMI and gamma (γ)-glutamyl transpeptidase for children suffering TIDM (P<0.05). Multiple linear regression analysis showed that BMI may be a factor influencing DPP-4 level in serum of T1DM children. In conclusion, the level of DPP-4 in serum increased, and insulin treatment was able to decrease DPP-4 level in T1DM children. However, clinical nutritional intervention could not improve the level of DPP-4 and BMI may be an influental factor of the DPP-4 level.