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Am J Physiol Endocrinol Metab 292: E871-E883, 2007. First published November 14, 2006; doi:10.1152/ajpendo.00551.2006
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Thiazolidinediones improve beta-cell function in type 2 diabetic patients

Amalia Gastaldelli,1,2 Ele Ferrannini,1,2 Yoshinori Miyazaki,1 Masafumi Matsuda,1 Andrea Mari,3 and Ralph A. DeFronzo1

1Diabetes Division, Department of Medicine, University of Texas Health Science Center, San Antonio, Texas; 2Metabolism Unit, Department of Internal Medicine, University of Pisa School of Medicine and Institute of Clinical Physiology, National Research Council, Pisa; and 3CNR Institute of Biomedical Engineering, Padua, Italy

Submitted 10 October 2006 ; accepted in final form 8 November 2006

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/m2; fasting plasma glucose (FPG) 10.3 ± 0.4 mM; Hb A1c 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 mUm–2min–1) clamp with [3-3H]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 A1c, and insulin-mediated total body glucose disposal (Rd) 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) ÷ IR] was significantly improved in all TZD-treated groups: +1.8 ± 0.7 (PIO + drug-naïve diabetics), +0.7 ± 0.3 (PIO + sulfonylurea-treated diabetics), and 0.7 ± 0.2 (ROSI + sulfonylurea-withdrawn diabetics) vs. –0.2 ± 0.3 in the two placebo groups (P 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 Rd 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.

type 2 diabetes; insulin secretion; insulin secretion/insulin resistance index


Address for reprint requests and other correspondence: R. A. DeFronzo, Diabetes Division, Univ. of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78229 (e-mail: albarado{at}uthscsa.edu)


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Drug Improves Beta Cell Function


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