Anti-diabetic Combination Therapy with Pioglitazone or Glimepiride Added to Metformin on the AGE-RAGE Axis: a Randomized Prospective Study.

Introduction: The ratio between advanced glycation end products (AGEs) and soluble form of receptor (s-RAGE) has been proposed as a risk marker for renal and cardiovascular diseases. The aim of this study was to evaluate in the diabetes condition the influence of two different oral anti-diabetic treatments on the AGE/ s-RAGE ratio, during a 5-year observation period. Methods: Seventy-three patients with type 2 diabetes mellitus were randomly assigned to a drug therapy with pioglitazone or glimepiride, combined to metformin. Each subject was evaluated at baseline and after 5 years of treatment. Results: In both groups s-RAGE levels did not significantly vary, while the levels of AGE and AGE/s-RAGE were both significantly reduced, basal compared to 5-year values. Within pioglitazone group, as well within glimepiride group, significant variations (Delta, as difference between 5 years of treatment minus basal) were observed for AGE (Delta=.21.1 +/- 13.4 mu g/ml, P<0.001 for pioglitazone; Delta=.14.4 +/- 11.4 mu g/ml, P<0.001 for glimepiride) and in AGE/s-RAGE (Delta= -0.037 +/- 0.022 mu g/pg, P<0.001 for pioglitazone; Delta= -0.024 +/- 0.020 mu g/pg, P<0.001 for glimepiride), suggesting an average decrease of the parameters by more than 50% in both treatments. Pioglitazone was more effective than glimepiride in reducing AGE/sRAGE ratio after 5 years of therapy. Conclusion: These data can help to explain the benefits of oral anti-diabetic therapy in relation to the reduction of cardiovascular risk, as suggested by variations in AGE/s-RAGE ratio as biochemical marker of endothelial function; in particular, treatment with pioglitazone seems to offer greater long-term benefit on AGE-RAGE axis.