Pioglitazone to Prevent Progression to Diabetes

Jamaluddin Moloo, MD, MPH; Thomas L. Schwenk, MD

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In This Article

Abstract and Introduction

Abstract

This drug lowered risk for progression but raised risk for edema and weight gain.

Introduction

Patients with impaired glucose tolerance are at elevated risk for adverse cardiovascular events and progression to diabetes. To assess whether pioglitazone (Actos) can prevent or slow progression to diabetes, Texas researchers randomized 602 patients with impaired glucose tolerance to placebo or pioglitazone (starting dose of 30 mg, titrated to a target of 45 mg daily). Mean follow-up in this industry-supported trial was 2.4 years.

More placebo recipients (17%) than pioglitazone recipients (5%) progressed to diabetes. Mean glycosylated hemoglobin (HbA1c) levels rose by 0.2% in the placebo group and remained unchanged in the pioglitazone group. Carotid intima–media thickness increased more slowly in the pioglitazone group. Pioglitazone recipients had more edema (13% vs. 6%) and greater weight gain (3.9 kg vs. 0.8 kg). The rate of congestive heart failure did not differ between groups.

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