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To the Editor: The CHICAGO (Carotid Intima-Media Thickness in Atherosclerosis Using Pioglitazone) trial by Dr Mazzone and colleagues¹ found a reduced progression of carotid artery intima-media thickness (CIMT) in patients with type 2 diabetes mellitus taking pioglitazone for 18 months, compared with those taking glimepiride. There was no regression of CIMT in either treatment group.

However, the absolute decrease in mean glycosylated hemoglobin (HbA_1c) level was only between 0.3% and 0.4%, which is less than expected based on other studies in patients with similar starting HbA1c values.² It is surprising that the mean HbA_1c value in the glimepiride group returned to baseline by 18 months despite ongoing glimepiride treatment. The treatment comparison appears to be between a weak hypoglycemic insulin-sensitizer (pioglitazone) and an ineffective secretagogue (glimepiride).

Given this, the difference in overall glycemic control between groups might have played a role in the results for changes in CIMT and . . . [Full Text of this Article]

Dario Giugliano, MD, PhD
dario.giugliano@unina2.it

Katherine Esposito, MD, PhD
Department of Geriatrics and Metabolic Diseases
University of Naples SUN
Naples, Italy

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Effect of Pioglitazone Compared With Glimepiride on Carotid Intima-Media Thickness in Type 2 Diabetes: A Randomized Trial
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