Pioglitazone halves mortality risk in insulin-dependent type 2 diabetes
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Adults with type 2 diabetes prescribed a combination of insulin and pioglitazone therapy were 50% less likely to die during follow-up when compared with adults prescribed insulin without pioglitazone, with findings driven by a lower risk for noncardiovascular death, according to findings published in The Journal of Clinical Endocrinology & Metabolism.
“The combination of insulin and pioglitazone lowered the risk for all-cause mortality compared with pioglitazone nonusers,” Chih-Cheng Hsu, MD, DrPH, deputy director of the Institute of Population Health Sciences, National Health Research Institutes, Taiwan, told Endocrine Today. “Pioglitazone might be a beneficial complementary agent for insulin treatment; however, we needed to start with the low dose of pioglitazone to avoid the risk for hypoglycemia.”
In a retrospective study, Hsu and colleagues analyzed data from 2,579 adults with type 2 diabetes prescribed insulin and pioglitazone therapy matched with 2,579 adults with type 2 diabetes prescribed insulin but not pioglitazone therapy, using data from the National Health Insurance Research Database in Taiwan (mean age, 62 years; mean diabetes duration, 6 years). Researchers compared overall incidence rates of all-cause mortality and CV events between pioglitazone users (mean follow-up time, 3.51 years) and nonusers (mean follow-up time, 2.84 years).
During follow-up, the mortality rates of pioglitazone users vs. nonusers were 15.02 vs. 30.26 per 1,000 person-years, respectively, for an adjusted HR of 0.47 for pioglitazone users vs. nonusers (95% CI, 0.38-0.58). The adjusted HRs for CV and non-CV death were 0.78 (95% CI, 0.51-1.19) and 0.5 (95% CI, 0.38-0.66), respectively. There were no between-group differences in rates of new-onset heart failure, hospitalization for coronary artery disease or stroke.
“Several randomized controlled trials have reported that pioglitazone resulted in significant improvement in the glycemic control of insulin-treated patients with type 2 diabetes; however, these were all short-term clinical trials that did not evaluate long-term outcomes,” Hsu said. “This study compared the risks for all-cause mortality and major CV events between 2,579 pioglitazone users and 2,579 matched nonusers. ... This nationwide cohort study demonstrated that pioglitazone use reduced the risks for all-cause mortality and non-CV death for patients with type 2 diabetes prescribed insulin therapy.”
The researchers noted that the study was conducted on an intention-to-treat basis according to initial pioglitazone assessment, irrespective of subsequent change to other diabetes agents, and that data about the duration and dosage of pioglitazone use on follow-up were not available. – by Regina Schaffer
For more information:
Chih-Cheng Hsu, MD, DrPH, can be reached at the Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan; email: cch@nhri.edu.tw.
Disclosures: The authors report no relevant financial disclosures.
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