Effect of Pioglitazone on Energy Intake and Ghrelin in Diabetic Patients

OBJECTIVE - To measure ghrelin and energy intake in the laboratory after pioglitazone treatment. RESEARCH DESIGN AND METHODS - 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 10 16 differed by group. RESULTS - 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. CONCLUSIONS - A portion-controlled diet attenuated the increase in energy intake after pioglitazone. Ghrelin responded to weight change not pioglitazone exposure.