Editing Pioglitazone (section)

==Medical uses==
Pioglitazone is used to lower blood glucose levels in [[type 2 diabetes]] either alone or in combination with [[sulfonylurea]], [[metformin]], or [[insulin]].<ref name="Actos FDA label">{{cite web | title=Actos- pioglitazone tablet | website=DailyMed | date=25 January 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d2ddc491-88a9-4063-9150-443b4fa4330c | access-date=13 February 2020 | archive-date=6 September 2015 | archive-url=https://web.archive.org/web/20150906115408/http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d2ddc491-88a9-4063-9150-443b4fa4330c | url-status=live }}</ref> The effects of pioglitazone have been compared in a Cochrane systematic review to that of other blood sugar lowering-medicine, including metformin, [[acarbose]], and [[repaglinide]], as well as with appropriate diet and exercise, not showing any benefit in reducing the chance of developing type 2 diabetes in people at risk.<ref name=":0">{{cite journal | vauthors = Ipsen EØ, Madsen KS, Chi Y, Pedersen-Bjergaard U, Richter B, Metzendorf MI, Hemmingsen B | title = Pioglitazone for prevention or delay of type 2 diabetes mellitus and its associated complications in people at risk for the development of type 2 diabetes mellitus | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 11 | pages = CD013516 | date = November 2020 | pmid = 33210751 | pmc = 8092670 | doi = 10.1002/14651858.CD013516.pub2 | collaboration = Cochrane Metabolic and Endocrine Disorders Group }}</ref> It did, however, show reduction of risk of developing type 2 diabetes when compared to a placebo or to no treatment.<ref name=":0" /> These results should be interpreted considering that most of the data of the studies included in this review were of low or very-low certainty.

While pioglitazone does decrease blood sugar levels, the main study that looked at the medication found no difference in the main cardiovascular outcomes that were looked at.<ref name="Scheen2012">{{cite journal | vauthors = Scheen AJ | title = Outcomes and lessons from the PROactive study | journal = Diabetes Research and Clinical Practice | volume = 98 | issue = 2 | pages = 175–86 | date = November 2012 | pmid = 23020930 | doi = 10.1016/j.diabres.2012.09.001 | hdl = 2268/132794 | quote = Since 2005, there has been much debate on the relative value of the statistically non-significant 10% reduction in the quite challenging primary composite endpoint (combining cardiovascular disease-driven and procedural events in all vascular beds) versus the statistically significant 16% decrease in the more robust and conventional main secondary endpoint (all-cause mortality, myocardial infarction, and stroke) observed with pioglitazone. | url = http://orbi.ulg.ac.be/jspui/handle/2268/132794 | access-date = 18 September 2019 | archive-date = 28 January 2021 | archive-url = https://web.archive.org/web/20210128055222/https://orbi.uliege.be//handle/2268/132794 | url-status = live | hdl-access = free }}</ref> The secondary outcome of death from all causes, myocardial infarction, and stroke were lower.<ref name="Scheen2012" />

Pioglitazone has been found to reduce all-cause mortality in type 2 diabetic patients compared to other therapies, with a 60% reduction in mortality in those exposed to pioglitazone, compared to those never exposed.<ref>{{cite journal | vauthors=Strongman H, Korhonen P, Williams R, et al | date=2017 | title=Pioglitazone and risk of mortality in patients with type 2 diabetes: results from a European multidatabase cohort study | journal=BMJ Open Diabetes Research & Care | volume=5 | issue=1 | pages=e000364 | doi=10.1136/bmjdrc-2016-000364 | pmid=28761650 | pmc=5530248 }}</ref> Another study found an all-cause mortality [[hazard ratio]] of 0.33  for pioglitazone after adjusting for >40 covariates, compared to insulin.<ref>{{cite journal | vauthors=Yang J, Vallarino C, Bron M, Perez A, Liang H, Joseph G, Yu S | date=2014| title= A comparison of all-cause mortality with pioglitazone and insulin in type 2 diabetes: an expanded analysis from a retrospective cohort study|volume=30|issue=11|pages=2223–2231|doi=10.1185/03007995.2014.941054 |journal=Current Medical Research and Opinion| pmid=24983744| s2cid=35665797}}</ref> Due to insufficient data on all-cause mortality, cardiovascular mortality, myocardial infarction and stroke, this was not possible to compare in a more recent review.<ref name=":0" />