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Diabetes and endocrinology
Research
Pioglitazone and cardiovascular outcomes in patients with insulin resistance, pre-diabetes and type 2 diabetes: a systematic review and meta-analysis
  1. Hung-Wei Liao1,
  2. Jeffrey L Saver2,
  3. Yi-Ling Wu3,
  4. Tso-Hsiao Chen4,
  5. Meng Lee5,
  6. Bruce Ovbiagele6
  1. 1Jia-Yi Clinic, Taoyuan, Taiwan
  2. 2UCLA Stroke Center, Los Angeles, California, USA
  3. 3Department of Neurology, Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
  4. 4Department of Nephrology, School of Medicine, College of Medicine, Taipei Medical University, Wan Fang Hospital, Taipei, Taiwan
  5. 5Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
  6. 6Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Meng Lee; menglee5126{at}gmail.com

Abstract

Objectives To evaluate the effect of pioglitazone in people with insulin resistance, pre-diabetes and type 2 diabetes.

Design and setting Systematic review and meta-analysis of randomised, controlled trials.

Data sources Literature searches were performed across PubMed, EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials from 1966 to May 2016 to identify randomised, controlled trials with more than 1 year follow-up.

Outcome measures Relative risk (RR) with 95% CI was used to evaluate the association between pioglitazone and the risk of major adverse cardiovascular events (MACE: composite of non-fatal myocardial infarction, non-fatal stroke and cardiovascular death) and safety outcomes, after pooling data across trials in a fixed-effects model.

Results Nine trials with 12 026 participants were enrolled in the current meta-analysis. Pioglitazone therapy was associated with a lower risk of MACE in patients with pre-diabetes or insulin resistance (RR 0.77, 95% CI 0.64 to 0.93), and diabetes (RR 0.83, 95% CI 0.72 to 0.97). Risks of heart failure (RR 1.32; CI 1.14 to 1.54), bone fracture (RR 1.52, 95% CI 1.17 to 1.99), oedema (RR, 1.63; CI 1.52 to 1.75) and weight gain (RR 1.60; CI 1.50 to 1.72) increased in pioglitazone group.

Conclusions Pioglitazone was associated with reduced risk of MACE in people with insulin resistance, pre-diabetes and diabetes mellitus. However, the risks of heart failure, bone fracture, oedema and weight gain were increased.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-013927

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    Footnotes

    • Contributors H-WL acquisition of data, analysis and interpretation of data, wrote the first draft. JLS analysis and interpretation of data, critical revision of manuscript for intellectual content. Y-LW acquisition of data, critical revision of manuscript for intellectual content. T-HC critical revision of manuscript for intellectual content. ML study concept and design, acquisition of data, analysis and interpretation of data, critical revision of manuscript for intellectual content. BO study supervision, critical revision of manuscript for intellectual content.

    • Funding This work was supported by Ministry of Science and Technology, Taiwan, grant number: MOST104-2314-B-182-019 and MOST105-2628-B-182-008-MY2.

    • Competing interests None declared.

    • Ethics approval This is a meta-analysis based on published articles.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.