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Pioglitazone for diabetes prevention
Pioglitazone reduces the risk of development of diabetes among prediabetic patients, according to a new study. Pioglitazone was compared to placebo in a total of 600 patients with impaired glucose tolerance. After a median follow-up of 2.4 years, the annualized incident rates for type 2 diabetes were 2.1% in the pioglitazone group and 7.6% in the placebo group (HR 0.28, 95% CI, 0.16 to 0.49; P < 0.001). Conversion to normal glucose tolerance occurred in nearly half of the pioglitazone group and in 20% of the placebo group (P < 0.001) and treatment with pioglitazone was associated with significantly lower fasting glucose levels, 2-hour glucose levels, and hemoglobin A1c levels. Pioglitazone also was associated with a decrease in diastolic blood pressure (2.0 mmHg vs 0.0 placebo), reduced rates of carotid intimal-medial thickening (P = 0.047), and an increased level of HDL cholesterol (increase of 7.35 mg/dL vs 4.5 mg/dL; P = 0.008). Pioglitazone caused greater weight gain than placebo (3.9 kg vs 0.77 kg; P < 0.001), as well as edema (12.9% vs 6.4%; P = 0.007). The authors conclude that pioglitazone reduced the risk of conversion of impaired glucose tolerance to type 2 diabetes but was associated with significant weight gain and edema (N Engl J Med 2011;364:1104-1115). Thiazolidinediones have been falling out of favor in recent years for the treatment of type 2 diabetes due to association with edema and heart failure. This new industry-sponsored study suggests that pioglitazone (Actos) is more effective than metformin or lifestyle changes in preventing conversion of prediabetes to diabetes. What is unclear is the effect of these various interventions on long-term diabetic complications.