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

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.

Automated summary

Pioglitazone improves glycaemic control by enhancing beta cell function and reducing insulin resistance. It also has positive effects on cardiac risk factors and cardiovascular disease, lowering the incidence of cardiac events in diabetic patients. Pioglitazone is effective in reducing the recurrence of transient ischaemic attack and ischaemic stroke in non-diabetic, insulin-resistant subjects. Additionally, it improves diastolic function in heart failure patients and decreases the incidence of atrial fibrillation through atrial remodelling suppression. Pioglitazone also shows potential in improving insulin resistance-related diseases, such as non-alcoholic steatohepatitis and polycystic ovary disease, as well as dermatopathies like psoriasis. However, biases from the toxicities of other thiazolidinediones have led to underutilization of pioglitazone.