Comparison of the effects of long-term pioglitazone and rosiglitazone therapy on liver enzymes in type 2 diabetes

Abstract

Aims

Insulin resistance is a major factor influencing the progression of non-alcoholic fatty liver disease (NAFLD). Hence, insulin sensitisers such as thiazolidinediones (TZDs) are a potential treatment for NAFLD although their long-term benefits remain unknown.

Methods

We retrospectively studied 396 and 364 type 2 diabetes patients who received pioglitazone and rosiglitazone therapy respectively from diabetes clinics between May 2001 and November 2007.

Results

One hundred and seventy-seven pioglitazone-treated and 152 rosiglitazone-treated patients were included. After a year of treatment, significant improvement in glycated haemoglobin A_1C (HbA_1C), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) was observed in both groups despite weight gain. Changes in HbA_1C and liver function test (LFT) were positively correlated in pioglitazone-treated (ALT p=0.01; GGT p<0.001; ALP p=0.006) and rosiglitazone-treated (GGT p= 0.01, ALP p=0.002) groups. Multiple regression showed no significant difference in the changes in ALT (p=0.43) and GGT (p=0.13) between the groups but a larger reduction in ALP (p=0.03) was noted in rosiglitazone-treated patients. Sixty patients remained on pioglitazone and 46 patients continued on rosiglitazone after four years. Sustained improvement in ALT, GGT and HbA_1C was observed in both groups despite weight gain over four years.

Keywords

fatty liver liver enzymes pioglitazone rosiglitazone type 2 diabetes

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