In praise of pioglitazone: An economically efficacious therapy for type 2 diabetes and other manifestations of the metabolic syndrome

• Published in: Diabetes, obesity & metabolism Vol. 25; no. 11; pp. 3093 - 3102
• Main Authors: Bell, David S. H., Jerkins, Terri
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-11-2023; Wiley Subscription Services, Inc
• Subjects: atrial fibrillation; beta cell rejuvenation; Beta cells; Cardiovascular diseases; Congestive heart failure; Diabetes; Diabetes mellitus (non-insulin dependent); Heart failure; Insulin resistance; Ischemia; Metabolic syndrome; myocardial infarction; non‐alcoholic steatohepatitis; Pioglitazone; polycystic ovary disease; Psoriasis; Risk factors; stroke; Thiazolidinediones; Transient ischemic attack; beta cell rejuvenation; heart failure; atrial fibrillation; pioglitazone; polycystic ovary disease; psoriasis; myocardial infarction; diabetes; insulin resistance; stroke; non-alcoholic steatohepatitis
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.15222

Pioglitazone improves glycaemic control, not only by lowering insulin resistance, but also by improving beta cell function. Because of the improved beta cell function the glycaemic control that occurs with pioglitazone is prolonged. Pioglitazone has positive effects not only on cardiac risk factors and surrogate measures of cardiovascular disease, it also lowers the incidence of cardiac events in patients with diabetes. The recurrence of transient ischaemic attack and ischaemic stroke is also reduced in non‐diabetic, insulin‐resistant subjects. Utilized at preclinical stages (but not later) of heart failure, pioglitazone improves diastolic function and avoids progression to heart failure. Pioglitazone, through suppression of atrial remodelling, also decreases the incidence of atrial fibrillation. The manifestations of diseases associated with insulin resistance (non‐alcoholic steatohepatitis and polycystic ovary disease) are also improved with pioglitazone. Pioglitazone may possibly improve psoriasis and other dermopathies. Pioglitazone is therefore an inexpensive and efficacious drug for the insulin‐resistant subject with diabetes that is underutilized because of biases that have evolved from the toxicities of other thiazolidinediones.