Does pioglitazone prevent or delay type 2 diabetes in people | Figure 1

%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)

Deleted account

Some actions are only available when you log in.

Report case

Report this to our moderators

Does pioglitazone prevent or delay type 2 diabetes in people at risk of developing type 2 diabetes?

You can view up to 4 cases without signing up Sign up for unlimited access

Does pioglitazone prevent or delay type 2 diabetes and its complications in people at risk of developing type 2 diabetes mellitus?

What is type 2 diabetes?

Type 2 diabetes, also known as adult‐onset diabetes, is the most common type of diabetes. It prevents the body from using insulin properly ‐ insulin is a hormone that helps the body to regulate blood sugar levels. People with type 2 diabetes may suffer long‐term effects (diabetic complications), such as eye or kidney disease, or develop foot ulcers. People with moderately elevated blood sugar levels (often referred to as 'prediabetes') are said to have an increased risk of developing diabetes. Pioglitazone is a blood sugar‐lowering medicine, which is used to treat people with type 2 diabetes.

What did we want to find out?

We wanted to know whether pioglitazone can also be used to prevent or delay type 2 diabetes in people at increased risk of developing the condition. We examined the effects of pioglitazone on important outcomes for patients, such as complications of diabetes, death from any cause, health‐related quality of life and unwanted effects of the treatment.

What did we do?

We searched for studies that investigated pioglitazone used to prevent or delay the onset of type 2 diabetes. Participants had to have elevated blood sugar levels, but lower than diagnostic levels for diabetes, and they needed to be free from other diseases. Studies had to apply the intervention (pioglitazone) for at least 24 weeks.

What we found

We found 27 randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) with a total of 4186 participants. The studies compared pioglitazone with other antidiabetic drugs, diet and exercise, placebo (a 'sham' treatment), or no intervention. Twenty‐three out of 27 studies were conducted in China. The studies lasted between 24 weeks and three years.

This evidence is up to date as of November 2019.

Key results

Five studies compared pioglitazone with other antidiabetic drugs (metformin, acarbose or repaglinide) and one study compared pioglitazone with diet and exercise. There were no clear beneficial or harmful effects on the risk of developing diabetes comparing the drugs.

Six studies compared pioglitazone with placebo. There was a reduction or delay in the development of type 2 diabetes: 188 out of 1000 people treated with placebo developed type 2 diabetes compared with 75 per 1000 people treated with pioglitazone (possible spread: 32 per 1000 to 179 per 1000).

Twenty‐three studies compared pioglitazone with no intervention. There was a reduction or delay in the development of type 2 diabetes: 193 out of 1000 people with no intervention developed type 2 diabetes compared with 60 per 1000 treated with pioglitazone (possible spread: 44 per 1000 to 77 per 1000).

Only a few studies reported death from any cause, serious unwanted effects, non‐fatal heart‐attacks or strokes. We were not able to detect any clear benefits or harms of pioglitazone for these outcomes. None of the included studies reported health‐related quality of life or socioeconomic effects (such as costs of the intervention, absence from work, medication consumption).

We found two ongoing studies that we could potentially include in this review. These studies may contribute data from around 2694 participants to future updates of our review.

Future research should focus on whether the effect of pioglitazone is sustained after people stop taking it. Furthermore, research should focus on patient‐important outcomes such as unwanted effects and complications of diabetes.

Quality of the evidence

All studies had problems in their methods or the way they reported results. Moreover, many outcomes were reported by no or just a few studies. We are therefore uncertain whether pioglitazone prevents or delays type 2 diabetes in people at risk of developing the condition.

Read the full Cochrane Review

Comment

Sign up to add a comment

More about this case

ResolvedVerified literature

Why you should join Figure 1

Sign up to explore now

Similar cases

\ \ Does raised blood sugar ('prediabetes') increase the risk of developing type 2 diabetes and how many of these people return to having normal blood sugar levels (normoglycaemia)?\ Cochrane Review; 103 observational studies, monitoring people over 1 to 24 years. More than 250,000 participants began the studies.\ Key results\ Generally, the development of new type 2 diabetes in people with prediabetes increased over time. However, many participants also reverted from prediabetes back to normal blood glucose levels. Compared to people with normoglycaemia, those with prediabetes showed an increased risk of developing type 2 diabetes, but results showed wide differences and depended on how prediabetes was measured. There were no clear differences with regard to several regions in the world or different populations. Because people with prediabetes may develop diabetes but may also change back to normoglycaemia almost any time, doctors should be careful about treating prediabetes because we are not sure whether this will result in more benefit than harm, especially when done on a global scale affecting many people worldwide.\ The certainty of the evidence for overall prognosis was moderate because results varied widely. The certainty of evidence for studies comparing prediabetic with normoglycaemic people was low because the results were not precise and varied widely.](https://app.figure1.com/case-detail/00690111-5ebe-4e5e-98b7-762ea3549fb3)

\ \ A new study suggests that the risk of developing type 2 diabetes (T2DM) could be significantly reduced through a diet rich in polyunsaturated omega-6 fats.\ While recent studies have raised concern that omega-6s could have negative health effects such as inflammation, more recent research supports clinical recommendations to increase intake of omega-6-rich foods.\ For the study, scientists analyzed data from 20 studies involving 39,740 adults from 10 countries, in which 4,347 new cases of diabetes occurred over time. They observed that higher proportions of linoleic acid biomarkers, such as the total percentage of fatty acids, were associated with a lower overall risk of type 2 diabetes. They also observed that arachidonic acid levels were not significantly associated with the risk of diabetes.\ "Some scientists have theorized that omega-6 would be harmful to health," said lead author Dr. Jason Wu of the George Institute for Global Health in Sydney. "However, based on a large global study, we found little evidence for damage and we actually found that the main omega-6 fat is linked to a lower risk of type 2 diabetes."\ Source: The Lancet Diabetes & Endocrinology.](https://app.figure1.com/case-detail/02f361da-2ecf-4c51-8624-e9247f308d32)

\ \ Diabetes drugs for preventing stroke and other blood vessel disease in people who have had a previous stroke or transient ischaemic attack\ Question\ We wanted to evaluate the effectiveness and safety of new diabetes drugs (peroxisome proliferator‐activated receptor gamma (PPAR‐γ) agonists) in the prevention of stroke and related blood vessel disease in people who have already had a stroke or transient ischaemic attack.\ Background\ Peroxisome proliferator‐activated receptor gamma agonists are drugs that improve the way insulin works in the human body. They are widely used in the treatment of adult type diabetes (type 2 diabetes). Moreover, they may also protect against the presence of excess fats in the blood and disease of the artery walls, which are both risk factors for stroke.\ Study characteristics\ We identified five studies to 30 July 2019 including a total of 5039 participants. Four studies evaluated the drug pioglitazone, and one study evaluated rosiglitazone. Four studies included participants who had no history of diabetes, and one study included only participants with diabetes.\ Key results\ Compared with placebo tablets, PPAR‐γ agonists reduced recurrent strokes and other blood vessel disease, improved the body's response to insulin, and stabilised fatty deposits in artery walls. The drugs also appeared to be well tolerated, but the evidence for this was inconclusive.\ Quality of the evidence\ Our conclusions should be interpreted with caution considering the small number of included studies and the limited quality of some of the studies. Further well‐designed randomised controlled trials with large sample sizes are required.](https://app.figure1.com/case-detail/0ef48586-4d60-494f-85fd-8a7ced887ced)

\ \ Cochrane Review; 10 trials (11,814 participants); 8 investigating acarbose & 2 investigating voglibose.\ Key results\ No trials reported amputation of lower limbs, blindness/severe vision loss, kidney disease, quality of life, time to progression to type 2 diabetes mellitus, or socioeconomic effects (e.g absence from work).\ Acarbose vs placebo:\ 670 of 4014 participants (17%) receiving acarbose developed type 2 diabetes vs. 812 of 3994 participants (20%) receiving placebo.\ Acarbose reduced the risk of heart attacks: one of 742 participants (0.1%) receiving acarbose had a heart attack vs. 15 of 744 (2%) receiving placebo. Acarbose treatment showed an increased risk of non‐serious side effects (mainly gastro‐intestinal events) vs. placebo: 751 of 775 people (97%) receiving acarbose had a non‐serious side effect vs. 723 of 775 people (93%) receiving placebo.\ Voglibose vs. placebo:\ 50 of 897 participants (5.6%) receiving voglibose developed type 2 diabetes vs. 106 of 881 (12%) receiving placebo.\ Acarbose vs. diet & exercise or vs. metformin:\ One trial (90 participants) compared acarbose with diet & exercise. Another trial (98 participants) compared acarbose with metformin. There were no important differences for any outcome for these comparisons.\ For most outcomes we are uncertain or very uncertain how valid the results of our comparisons are.](https://app.figure1.com/case-detail/5e7b4754-a6dc-437c-b6ae-f1643861a2ee)

Trending now

\ \ A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\ He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\ On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

\ \ A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\ Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

\ \ A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

\ \ patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)