Weighing the Benefits of Pioglitazone in Type 2 Diabetes

Pioglitazone (Actos), a peroxisome proliferator-activated receptor-γ (PPAR-γ) agonist, is used to improve insulin resistance in patients with type 2 diabetes. To test the drug’s effect on outcomes, researchers in Europe randomized 5238 patients (mean age, 62; 67% men) with type 2 diabetes and macrovascular disease to receive pioglitazone (titrated up to 45 mg/day) or placebo. All patients had HbA_1c levels above the upper limit of normal despite treatment with diet alone or with oral glucose-lowering agents (with or without insulin). This multicenter trial was partly supported by pioglitazone’s manufacturer. Mean follow-up was nearly 3 years.

Incidence of the primary composite endpoint (all-cause mortality, nonfatal MI, stroke, above-ankle le…