Favorable Effects of Pioglitazone and Metformin Compared With Gliclazide on Lipoprotein Subfractions in Overweight Patients With Early Type 2 Diabetes

OBJECTIVE — To compare effects of different oral hypoglycemic drugs as first-line therapy on lipoprotein subfractions in type 2 diabetes. RESEARCHDESIGNANDMETHODS — Sixty overweight type 2 diabetic patients not on lipid-lowering therapy were randomized to metformin, pioglitazone, or gliclazide after a 3-month dietary run-in. Drug doses were uptitrated for 3 months to optimize glycemia and were kept fixed for a further 3 months. LDL subfractions (LDL1, LDL2, and LDL3) were prepared by density gradient ultracentrifugation at randomization and study end. Triglycerides, cholesterol, total protein, and phospholipids were measured and mass of subfractions calculated. HDL subfractions were prepared by precipitation. The primary end point was change in proportion of LDL as LDL3. RESULTS — HbA1c, triglycerides, glucose, and cholesterol were comparable across groups at baseline and over time. LDL3 mass and the LDL3-to-LDL ratio fell with pioglitazone (LDL3 mass 36.2 to 28.0 mg/dl, P 0.01; LDL3-to-LDL 19.2:13.3%, P 0.01) and metformin (42.7 to 31.5 mg/dl, P 0.01; 21.3:16.2%, P 0.01, respectively) with no change on gliclazide. LDL3 reductions were associated with reciprocal LDL1 increases. Changes were independent of BMI