Adipose tissue secretes biologically active mediators as adipokines. We evaluate the effect of pioglitazone and acarbose on adipokines and vascular remodelling markers during an oral glucose tolerance test (OGTT). Height and body weight, BMI, glycemic and lipid profile, blood pressure, Nitrites/nitrates, ADP, resistin, MMP-2, and MMP-9 were evaluated at titration beginning, after 3, 6 months, and at the study end in 473 type 2 diabetic patients. BMI and weight increased after full treatment with pioglitazone respect to acarbose. HbA_1c decreased after titration period with pioglitazone compared to baseline and to acarbose, and after full treatment with pioglitazone compared to the end of titration period and to acarbose. FPG decreased after full treatment with pioglitazone compared to the end of titration period. PPG decreased with acarbose after titration period respect to baseline and after full treatment respect to the end of titration period. FPI and Homa index decreased after titration period with pioglitazone compared to baseline and to acarbose, and after full treatment with pioglitazone respect to the end of titration period and to acarbose. ADP increased after titration period with pioglitazone compared to baseline and to acarbose, and after full treatment with pioglitazone compared to the end of titration period and to acarbose. Resistin decreased after titration period with pioglitazone compared to baseline and to acarbose, and after full treatment with pioglitazone respect to acarbose. Pioglitazone improves glucose metabolism and insulin-resistance compared to acarbose in type 2 diabetic patients already treated with metformin and sulphonilureas.