In developed countries including Japan, in recent years, the incidence of obesity has sharply increased by the overintake of calorie-rich diet and exercise-lacking lifestyles.
1)Metabolic syndrome caused by obesity with abdominal adiposity especially is a strong risk factor for type 2 diabetes 2) and cardiovascular diseases.3) Obesity in humans generally involves the interaction of multiple genes and environmental factors.Pioglitazone, a thiazolidinedione that improves insulin resistance, has been widely used for the treatment of type 2 diabetes with obesity and insulin resistance. However, body weight gain is frequently observed in patients during the administration of pioglitazone.
4)On the other hand, metformin, a biguanide that improves insulin resistance similarly to pioglitazone, has been also widely used for the treatment of type 2 diabetes. It has been reported that obese patients with type 2 diabetes treated with metformin do not gain body weight; indeed many patients on this agent lose body weight by decreasing food consumption.5-8) However, the mechanisms by which metformin treatment causes reduction of food consumption and body weight loss are not fully clarified. It has been indicated that metformin increases plasma active glucagon-like peptide-1 (GLP-1) in obese nondiabetic subjects.9) GLP-1 is an incretin released from L cells in the intestine after oral ingestion of nutrients. This incretin has several actions such as stimulation of insulin biosynthesis, inhibition of glucagon secretion, and inhibition of gastric emptying in addition to promotion of satiety and inhibition of food intake.
10)Both metformin and pioglitazone are currently used as first-choice agents for the treatment for type 2 diabetes with obesity in Japan, even though they have opposite effects against body weight. Therefore it may be useful to clarify the differences in the effects of metformin and pioglitazone for prevention and treatment of obese type 2 diabetes and cardiovascular diseases produced as the result of development of metabolic syndrome. To investigate the effects of metformin on food intake and body weight gain, genetically obese diabetic mice such as db/db 11) or rats such as fa/fa, 12) GotoKakizaki (GK), 13) Otsuka Long-Evans Tokusima Fatty (OLETF), 14) and Zucker 15) have been generally used. However, daily oral administration of metformin to these genetically obese diabetic animals does not strongly affect body weight gain. On the other hand, we have recognized that daily treatment with pioglitazone given as food mixture (0.01, 0.02%) causes marked increases in food intake and body weight, although treatment with this drug removed hyperglycemia and hyperlipidemia. 16) Dietary fats are considered one of the most important environmental factors in the pathophysiology of obesity, and dietary fats-induced obesity is strongly related to lifestyle. However, it is unknown whether metformin causes body weight loss, while pioglitazone causes body weight gain, when administered to animals with high-fat diet-induced obes...