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Efficacy and safety of pioglitazone monotherapy in type 2 diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials
Alam, Fahmida Mohamed, Mafauzy Ahmad, Imran Kamal, Mohammad Amjad Donnelly, Richard Idris, Iskandar Gan, Siew Hua
Alam, Fahmida
Mohamed, Mafauzy
Ahmad, Imran
Kamal, Mohammad Amjad
Donnelly, Richard
Idris, Iskandar
Gan, Siew Hua
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Epub Date
Issue Date
2019-03-29
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Abstract
Pioglitazone, the only thiazolidinedione drug in clinical practice is under scrutiny due to reported adverse effects, it’s unique insulin sensitising action provides rationale to remain as a therapeutic option for managing type 2 diabetes mellitus (T2DM). We conducted a systematic review and meta-analysis comparing pioglitazone monotherapy with monotherapies of other oral antidiabetic drugs for assessing its efficacy and safety in T2DM patients. Mean changes in glycated haemoglobin (HbA1c), and mean changes in fasting blood sugar (FBS) level, body weight (BW) and homeostasis model assessment-insulin resistance (HOMA-IR) were primary and secondary outcomes, respectively. Safety outcomes were changes in lipid parameters, blood pressure and incidences of adverse events. Metafor package of R software and RevMan software based on random-effects model were used for analyses. We included 16 randomised controlled trials. Pioglitazone monotherapy showed equivalent efficacy as comparators in reducing HbA1c by 0.05% (95% CI: −0.21 to 0.11) and greater efficacy in reducing FBS level by 0.24 mmol/l (95% CI: −0.48 to −0.01). Pioglitazone showed similar efficacy as comparators in reducing HOMA-IR (WMD: 0.05, 95% CI: −0.49 to 0.59) and increasing high-density lipoprotein level (WMD: 0.02 mmol/l, 95% CI: −0.06 to 0.10). Improved blood pressure (WMD: −1.05 mmHg, 95% CI: −4.29 to 2.19) and triglycerides level (WMD: −0.71 mmol/l, 95% CI: −1.70 to 0.28) were also observed with pioglitazone monotherapy. There was a significant association of pioglitazone with increased BW (WMD: 2.06 kg, 95% CI: 1.11 to 3.01) and risk of oedema (RR: 2.21, 95% CI: 1.48 to 3.31), though the risk of hypoglycaemia was absolutely lower (RR: 0.51, 95% CI: 0.33 to 0.80). Meta-analysis supported pioglitazone as an effective treatment option for T2DM patients to ameliorate hyperglycaemia, adverse lipid metabolism and blood pressure. Pioglitazone is suggested to prescribe following individual patient’s needs. It can be a choice of drug for insulin resistant T2DM patients having dyslipidaemia, hypertension or history of cardiovascular disease.
Citation
Alam, F., Islam, M.A., Mohamed, M. et al. Efficacy and Safety of Pioglitazone Monotherapy in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Sci Rep 9, 5389 (2019). https://doi.org/10.1038/s41598-019-41854-2
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PubMed ID
30926892 (pubmed)
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Type
Journal article
Language
en
Description
© 2019 The Authors. Published by Nature Publishing Group. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website:
https://doi.org/10.1038/s41598-019-41854-2
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ISSN
2045-2322
EISSN
2045-2322
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Sponsors
We would like to acknowledge Universiti Sains Malaysia (USM) Global Fellowship (2014/2015) awarded to Fahmida Alam to pursue her PhD degree. There was no funding source for this study.
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Licence for published version: Creative Commons Attribution 4.0 International