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Pioglitazone for diabetes prevention in impaired glucose tolerance

Ralph A DeFronzo1, Devjit Tripathy, Dawn C Schwenke

  • 1Texas Diabetes Institute and University of Texas Health Science Center, San Antonio, TX 78229, USA. albarado@uthscsa.edu

The New England Journal of Medicine
|March 25, 2011
PubMed
Abstract

Insights

Pioglitazone significantly reduced the risk of developing type 2 diabetes in adults with impaired glucose tolerance. This intervention also improved glucose levels but was associated with weight gain and edema.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Clinical Pharmacology

Background:

  • Impaired glucose tolerance (IGT) is a precursor to type 2 diabetes mellitus (T2DM) and cardiovascular disease.
  • Early intervention for IGT is crucial for preventing T2DM and its complications.
  • Identifying effective pharmacological agents for IGT management is of significant clinical importance.

Purpose of the Study:

  • To evaluate the efficacy of pioglitazone in preventing the conversion of impaired glucose tolerance to type 2 diabetes mellitus.
  • To assess the impact of pioglitazone on glucose metabolism and cardiovascular risk markers in patients with IGT.

Main Methods:

  • A randomized, double-blind, placebo-controlled trial involving 602 adults with IGT.
  • Patients were randomized to receive either pioglitazone or a placebo for a median follow-up of 2.4 years.
  • Regular monitoring of fasting glucose, oral glucose tolerance tests, and confirmation of diabetes conversion were performed.

Main Results:

  • Pioglitazone reduced the annual incidence of T2DM by 72% compared to placebo (2.1% vs. 7.6%).
  • A higher proportion of patients in the pioglitazone group achieved normal glucose tolerance (48% vs. 28%).
  • Pioglitazone significantly lowered fasting glucose, 2-hour glucose, and HbA1c levels, and improved diastolic blood pressure and HDL cholesterol, but was associated with weight gain and edema.

Conclusions:

  • Pioglitazone effectively reduces the risk of progression from impaired glucose tolerance to type 2 diabetes mellitus.
  • The benefits of pioglitazone in improving glycemic control and metabolic parameters must be weighed against potential side effects like weight gain and edema.

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