Long-term outcomes of pioglitazone plus insulin in patients with type 2 diabetes

This study evaluated the impact of long-term pioglitazone (Actos) treatment on outcomes for patients with type 2 diabetes (T2D) taking insulin. The authors concluded that this treatment lowered mortality risk for these patients.

As T2D progresses, more intensive treatment may be required. Typically, this means increasing insulin doses. Unfortunately, even with insulin therapy, more than half of patients with T2D fail to reach their target blood glucose levels. Long-term insulin use is also associated with dangerously low blood glucose (hypoglycemia) and weight gain, which can lead to complications such as heart disease.

Pioglitazone is a non-insulin medication that can help increase insulin sensitivity. High insulin sensitivity means that the cells of the body can use blood glucose more effectively. This reduces blood glucose levels. Therefore, combining pioglitazone with insulin therapy may improve blood glucose control better than insulin alone. The long-term safety and benefit of pioglitazone plus insulin for patients with T2D are uncertain.

This study included the records of 5158 patients with T2D. All patients were already on insulin therapy. 2579 patients also received pioglitazone. These patients were compared to 2579 patients who received insulin but not pioglitazone. 41.95% and 42.26% of patients had heart disease at the time of the study. Patients were followed-up for an average of 2.84 to 3.51 years.

Pioglitazone treatment was significantly associated with a 53% lower mortality risk. Pioglitazone treatment also lowered the risk of heart-related mortality by 22%. Among patients with heart disease, pioglitazone treatment lowered mortality risk by 59%.

The risk of hospitalization due to heart disease, stroke, and heart failure was not significantly different between the two groups.

This study concluded that the combination of pioglitazone and insulin lowered mortality risk in patients with T2D compared to patients on insulin only. The authors suggest that pioglitazone may be an effective addition to insulin treatment.

This study was retrospective. This means it analyzed data that was already collected before. This may limit the conclusions that can be drawn from these results. More studies are needed to confirm these results.