(April 1, 2008 - Insidermedicine)  Thiazolidinedione pioglitazone (tradename Actos) is more effective than sulfonylurea glimepiride (tradename Amaryl) at slowing the progression of atherosclerotic disease among individuals with type 2 diabetes, according to research published in the Journal of the American Medical Association.

Here are some recommendations for preventing cardiovascular disease among patients with diabetes from the European Society of Cardiology:

•    Use early, stepwise increases in therapy towards pre-defined treatment targets to improve morbidity and mortality.

•    Use metformin as a first line drug in overweight patients with type 2 diabetes.

•    Consider early initiation of insulin in patients with type 2 diabetes failing their glucose target, and in patients with excessive post-prandial glucose excursions.

For the multicenter PERISCOPE trial out of the Cleveland Clinic, researchers randomized over 500 patients with type 2 diabetes to treatment with an insulin-providing strategy using glimepiride or an insulin-sensitizing strategy using pioglitazone. Prior to starting therapy, the patients underwent coronary intravascular ultrasonography to measure the degree of atherosclerotic plaque, and 360 patients underwent repeat measures to determine their response to therapy.

After 18 months of treatment, percent atheroma volume (PAV) increased 0.73% in the glimepiride group and decreased 0.16% in the pioglitazone group. In an alternate analysis in which baseline characteristics were used to estimate PAV among patients who did not have follow-up evaluations, PAV increased by 0.64% in the glimepiride-treated-group and decreased by 0.06% in those treated with pioglitazone.

Today's research suggests that an insulin-sensitizing strategy using pioglitazone slows the atherosclerotic process better than an insulin-providing strategy using glimepiride.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.