Effect of pioglitazone on energy intake and ghrelin in diabetic patients.

Abstract

To measure ghrelin and energy intake in the laboratory after pioglitazone treatment. This was a parallel, three-arm study with 51 obese diabetic subjects randomized to either 1) pioglitazone plus a portion-controlled diet (Pio+PC), 2) pioglitazone plus American Diabetes Association (ADA) dietary advice (Pio+ADA), or 3) metformin plus ADA advice (Met+ADA). Energy intake and the suppressive response of a meal on ghrelin were measured at weeks 0 and 16. Mixed models tested if changes from week 0 to 16 differed by group. The Pio+ADA group had a significantly larger increase (P < 0.05) in energy intake ([adjusted means +/- SE] 207 +/- 53 kcal) compared with the Pio+PC (50 +/- 46 kcal) and Met+ADA (52 +/- 49 kcal) groups. Change in restraint and disinhibition (variables associated with eating behavior) mediated weight change. Ghrelin suppression increased in the Pio+ADA group, which gained weight. A portion-controlled diet attenuated the increase in energy intake after pioglitazone. Ghrelin responded to weight change not pioglitazone exposure.