Thiazolidinediones improve beta-cell function in type 2 diabetic patients

Thiazolidinediones (TZDs) improve glycemic control and insulin sensitivity in patients with type 2 diabetes mellitus (T2DM). There is growing evidence from in vivo and in vitro studies that TZDs improve pancreatic beta-cell function. The aim of this study was to determine whether TZD-induced improvement in glycemic control is associated with improved beta-cell function. We studied 11 normal glucose-tolerant and 53 T2DM subjects [age 53 +/- 2 yr; BMI 29.4 +/- 0.8 kg/m(2); fasting plasma glucose (FPG) 10.3 +/- 0.4 mM; Hb A(1c) 8.2 +/- 0.3%]. Diabetic patients were randomized to receive placebo or TZD for 4 mo. Subjects received 1) 2-h OGTT with determination of plasma glucose, insulin, and C-peptide concentrations and 2) two-step euglycemic insulin (40 and 160 mU (.) m(-2) (.) min(-1)) clamp with [3-H-3] glucose. T2DM patients were then randomized to receive 4 mo of treatment with pioglitazone (45 mg/day), rosiglitazone (8 mg/day), or placebo. Pioglitazone and rosiglitazone similarly improved FPG, mean plasma glucose during OGTT, Hb A(1c), and insulin-mediated total body glucose disposal (R-d) and decreased mean plasma FFA during OGTT (all P < 0.01, ANOVA). The insulin secretion/insulin resistance (disposition) index [Delta ISR(AUC)/Delta glucose(AUC) divided by IR] was significantly improved in all TZD-treated groups: +1.8 +/- 0.7 (PIO + drug-naive diabetics), +0.7 +/- 0.3 (PIO + sulfonylurea-treated diabetics), and 0.7 +/- 0.2 (ROSI +/- sulfonylurea-withdrawn diabetics) vs. -0.2 +/- 0.3 in the two placebo groups (P < 0.01, all TZDs vs. placebo, ANOVA). Improved insulin secretion correlated positively with increased body weight, fat mass, and R-d and inversely with decreased plasma glucose and FFA during the OGTT. In T2DM patients, TZD treatment leads to improved beta-cell function, which correlates strongly with improved glycemic control.