Effects of Pioglitazone on Blood Glucose and Inflammatory Markers of Diabetic Kidney Transplant Patients: A Randomized Controlled Trial

Introduction. The aim of this study was to assess the effects of pioglitazone on blood glucose control and inflammatory biomarkers in diabetic patients receiving insulin after kidney transplantation. Materials and Methods. In a randomized placebo-controlled trial, 62 diabetic kidney transplant patients were followed for 4 months after randomly assigned to placebo and pioglitazone (30 mg/d) groups. All of the patients continued their insulin therapy irrespective of the group that they were assigned to, in order to evaluate the effects of addition of pioglitazone on blood glucose and inflammation biomarkers including serum C-reactive protein, high-sensitivity C-reactive protein, and interleukin-18 levels, as well as erythrocyte sedimentation rate. Results. At baseline, there were no significant differences in laboratory studies between the two groups. After 4 months of intervention, along with significant improvement in hemoglobin A1c in the pioglitazone group, daily insulin requirements also decreased and lipid profile improved significantly. In addition, erythrocyte sedimentation rate, C-reactive protein, and high-sensitivity C-reactive protein values were significantly lower in the pioglitazone group (P = .03, P .001, and P = .01). Interleukin-18 levels were not significantly different at the end of the study between the two groups, but it had a decreasing trend in the pioglitazone group (P = .002). Conclusions. Pioglitazone complementing insulin in diabetic kidney transplant patients not only improved glycemic control, evidenced by hemoglobin A1c, and reduced daily insulin requirement, but also decreased inflammatory markers which may have an impact on overall cardiovascular events and mortalities beyond glycemic control.