Rosiglitazone is more effective than metformin in improving fasting indexes of glucose metabolism in severely obese, non-diabetic patients

  1. A. Brunani1,*,
  2. A. Caumo2,
  3. S. Graci1,
  4. G. Castagna1,
  5. G. Viberti3,
  6. A. Liuzzi1

Article first published online: 29 MAR 2007

DOI: 10.1111/j.1463-1326.2007.00728.x

Issue

Diabetes, Obesity and Metabolism

Diabetes, Obesity and Metabolism

Volume 10, Issue 6, pages 460–467, June 2008

Additional Information

How to Cite

Brunani, A., Caumo, A., Graci, S., Castagna, G., Viberti, G. and Liuzzi, A. (2008), Rosiglitazone is more effective than metformin in improving fasting indexes of glucose metabolism in severely obese, non-diabetic patients. Diabetes, Obesity and Metabolism, 10: 460–467. doi: 10.1111/j.1463-1326.2007.00728.x

Author Information

  1. 1

    Department of Internal Medicine, Ospedale San Giuseppe, IRCCS, Istituto Auxologico Italiano, Verbania, Italy

  2. 2

    Nutrition and Metabolism Unit, San Raffaele Scientific Institute, Milano, Italy

  3. 3

    Departement of Diabetes and Endocrinology, GKT School of Medicine, Guy’s Hospital, King’s College London, London, UK

*Dr Amelia Brunani, Ospedale San Giuseppe, Piancavallo, 28900 Verbania, Italy. E-mail: brunani@auxologico.it

Publication History

  1. Issue published online: 29 MAR 2007
  2. Article first published online: 29 MAR 2007
  3. Received 8 November 2006; returned for revision 20 February 2007; revised version accepted 21 February 2007

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Keywords:

  • β-cell function;
  • insulin sensitivity;
  • metformin;
  • obesity;
  • rosiglitazone

Aim:  In obese patients, the diet-induced weight loss markedly improves glucose tolerance with an increase in insulin sensitivity and a partial reduction of insulin secretion. The association with metformin treatment might potentiate the effect of diet alone.

Methods:  From patients admitted to our Nutritional Division for diet programme, we selected obese, non-diabetic, uncomplicated patients with age 18–65 years and body mass index 35–50 kg/m2 and studied the effects of a 6-month pharmacological treatment with either metformin (850 mg twice daily) or rosiglitazone (4 mg twice daily) on possible changes in body weight, fat mass, glucose and lipids metabolism.

Results:  A significant weight loss and reduction of fat mass was demonstrated with metformin (−9.7 ± 1.8 kg and −6.6 ± 1.1 kg) and also with rosiglitazone (−11.0 ± 1.9 kg and −7.2 ± 1.8 kg), without fluid retention in either treatment group. Rosiglitazone administration induced a significant decrease in glucose concentration (4.7 ± 0.1 vs. 4.4 ± 0.1 mmol/l, p < 0.005) and insulin-circulating level (13.6 ± 1.5 vs. 8.0 ± 0.,7 μU/ml, p < 0.005), an increase in insulin sensitivity as measured by homeostatic model assessment (HOMA) of insulin sensitivity (68.9 ± 8.8 vs. 109.9 ± 10.3, p < 0.005) with a concomitant decrease in β-cell function as measured by HOMA of β-cell function (163.2 ± 16.1 vs. 127.4 ± 8.4, p < 0.005). In contrast, metformin did not produce any significant effect on blood glucose concentration, insulin level and HOMA2 indexes. No adverse events were registered with pharmacological treatments.

Conclusion:  Our study shows that in severely obese, non-diabetic, hyperinsulinaemic patients undergoing a nutritional programme, rosiglitazone is more effective than metformin in producing favourable changes in fasting-based indexes of glucose metabolism, with a reduction of both insulin resistance and hyperinsulinaemia. In spite of previous studies reporting rosiglitazone-induced body weight gain, in our study the joint treatment with diet and rosiglitazone was accompanied by weight loss and fat mass reduction.

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