OBJECTIVE To examine the effect of pioglitazone on myocardial insulin sensitivity and left ventricular (LV) function in patients with type 2 diabetes (T2D).

RESEARCH DESIGN AND METHODS Twelve subjects with T2D and 12 with normal glucose tolerance received a euglycemic insulin clamp. Myocardial glucose uptake (MGU) and myocardial perfusion were measured with [¹⁸F]fluoro-2-deoxy-d-glucose and [¹⁵O]H₂O positron emission tomography before and after 24 weeks of pioglitazone treatment. Myocardial function and transmitral early diastolic relation/atrial contraction (E/A) flow ratio were measured with magnetic resonance imaging.

RESULTS Pioglitazone reduced HbA_1c by 0.9%; decreased systolic and diastolic blood pressure by 7 ± 2 and 7 ± 2 mmHg, respectively (P < 0.05); and increased whole-body insulin-stimulated glucose uptake by 71% (3.4 ± 1.3 to 5.8 ± 2.1 mg/kg · min; P < 0.01) in subjects with T2D. Pioglitazone enhanced MGU by 75% (0.24 ± 0.14 to 0.42 ± 0.13 μmol/min · g; P < 0.01) and myocardial perfusion by 16% (0.95 ± 0.16 to 1.10 ± 0.25 mL/min · g; P < 0.05). Measures of diastolic function, E/A ratio (1.04 ± 0.3 to 1.25 ± 0.4) and peak LV filling rate (349 ± 107 to 433 ± 99 mL/min), both increased (P < 0.01). End-systolic volume, end-diastolic volume, peak LV ejection rate, and cardiac output trended to increase (P not significant), whereas the ejection fraction (61 ± 6 to 66 ± 7%) and stroke volume increased significantly (71 ± 20 to 80 ± 20 L/min; both P < 0.05).

CONCLUSIONS Pioglitazone improves whole-body and myocardial insulin sensitivity, LV diastolic function, and systolic function in T2D. Improved myocardial insulin sensitivity and diastolic function are strongly correlated.

目的探讨吡格列酮对2型糖尿病（T2D）患者胰岛素敏感性和左心室（LV）功能的影响。

研究设计和方法12名T2D受试者和12名葡萄糖耐量正常的受试者接受了正常血糖钳夹。心肌葡萄糖摄取（MGU）和心肌灌注用测定[ ¹⁸ F]氟-2-脱氧d -葡萄糖和[ ¹⁵ O] H ^ ₂ ö正电子发射断层摄影术之前和吡格列酮治疗24周后。通过磁共振成像测量心肌功能和经皮早期舒张期关系/心房收缩（E / A）流量比。

结果吡格列酮使HbA _1c降低了0.9％。收缩压和舒张压分别降低7±2和7±2 mmHg（P <0.05）；在患有T2D的受试者中，胰岛素刺激的全身葡萄糖摄取量增加了71％（3.4±1.3至5.8±2.1 mg / kg·min；P <0.01）。吡格列酮使MGU增强75％（0.24±0.14至0.42±0.13μmol/ min·g; P <0.01），心肌灌注提高16％（0.95±0.16至1.10±0.25 mL / min·g; P <0.05）。舒张功能，E / A比（1.04±0.3至1.25±0.4）和峰值左室充盈率（349±107至433±99 mL / min）的测量均增加（P<0.01）。收缩末期容积，舒张末期容积，左室射血峰值和心输出量趋于增加（P不显着），而射血分数（61±6至66±7％）和中风量显着增加（71±20）至80±20 L / min;均P <0.05）。

结论吡格列酮可改善T2D的全身和心肌胰岛素敏感性，LV舒张功能和收缩功能。改善的心肌胰岛素敏感性和舒张功能密切相关。