Rosiglitazone Decreases C-Reactive Protein (CRP) Relative to Glyburide and Metformin over Four-Years in Spite of Greater Weight Gain.

In A Diabetes Outcomes Progression Trial (ADOPT), rosiglitazone (RSG) was shown to decrease progression to monothempy failure relative to glyburide (GLY) and metformin (MET) in recently diagnosed type 2 diabetic patients. We previously reported that obesity at baseline was the main determinant of C-reactive protein (CRP) in these patients. While thiazolidinediones (TZDs) have been shown to reduce inflammation, as measured by high sensitivity CRP, previous studies have been short-term and small and therefore have been unable to assess whether the increased weight gain with TZDs might attenuate their effects on CRP. We examined this issue in 783 patients from the North American Cohort of ADOPT with a median follow-up of 4.0 years. The median body mass index at baseline was 32.8 kg/m² and was similar in each treatment group. The median baseline CRP values were 4.5 mg/L for RSG, 3.7 mg/L for GLY, and 4.2 mg/L for MET. All treatments decreased CRP levels from baseline, but RSG decreased CRP levels by 47.6% (95% CI = 57.8%, 35.0%, p< 0.0001) relative to GLY and 30.5% (43.3 %, 14.9%, p=0.0004) relative to MET in spite of greater weight gain with RSG compared to both GLY by 3.85 kg (95% CI=2.39, 5.31) and MET by 8.56 kg (95% CI=7.16, 9.95). Thus, although the mechanism is unclear, RSG decreases inflammation relative to metformin and glyburide in spite of greater weight gain during four years of follow up. [ABSTRACT FROM AUTHOR]