Metabolic effects of troglitazone therapy in type 2 diabetic, obese, and lean normal subjects

OBJECTIVE- To characterize metabolic effects of troglitazone in type 2 diabetic, obese, and lean subjects, and examine the effects of troglitazone 2-3 weeks after discontinuation. RESEARCH DESIGN AND METHODS- Nine type 2 diabetic, nine obese, and nine lean subjects underwent baseline metabolic studies including an 8-h meal-tolerance test (MTI) and a 5-h glucose clamp. Subjects then received troglitazone (600 mg/day) for 12 weeks and subsequently had repeat metabolic studies. Diabetic subjects remained off hypoglycemic agents for 2-3 weeks and then underwent a 5-h glucose clamp. RESULTS- In diabetic subjects, fasting plasma glucose was reduced (P < 0.05) and insulin-stimulated glucose disposal (R-d) was enhanced by treatment (P < 0.02). The area under the MTT 8-h plasma glucose curve declined with therapy (P < 0.001), and its change was positively correlated with the improvement in R-d (r = 0.75, P < 0.05). There was also a positive correlation between the change in fasting hepatic glucose output (HGO) and the change in fasting plasma glucose with treatment (r = 0.92, P < 0.001). Discontinuation of therapy for 2-3 weeks did not significantly affect fasting plasma glucose or insulin-stimulated glucose R-d. In obese subjects, insulin-stimulated glucose R-d improved with therapy (P < 0.001), allowing for maintenance of euglycemia by lower plasma insulin concentrations (P < 0.05). In lean subjects, an increase in fasting HGO (P < 0.001) and glucose clearance (P < 0.01) was observed. CONCLUSIONS- Troglitazone lowers fasting and postprandial plasma glucose in type 2 diabetes by affecting both fasting HGO and peripheral insulin sensitivity. Its effects are evident 2-3 weeks after discontinuation. In obese subjects, its insulin sensitizing effects suggest a role for its use in the primary prevention of type 2 diabetes.