Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Pioglitazone & Decreased Risk of Diabetes

Diabetes Care; ePub 2016 Jul 27; Inzucchi, et al

Publish date:

Pioglitazone decreased the risk of diabetes while also reducing the risk of subsequent ischemic events among insulin-resistant but nondiabetic patients, according to a recent study. The Insulin Resistance Intervention after Stroke (IRIS) trial included 3,876 patients with recent ischemic stroke or transient ischemic attack (TIA), no history of diabetes, fasting plasma glucose (FPG) <126 mg/dL, and insulin resistance by homeostatis model assessment of insulin resistance (HOMA-IR) score >3.0, and randomly assigned to pioglitazone or placebo. Researchers found:

• At baseline, the mean FPG and HbA1c were 98.2 mg/dL and 5.8%, respectively.

• After 1 year, mean FPG decreased to 95.1 mg/dL in the pioglitazone group and rose 99.7 mg/dL in the placebo group.

• Insulin resistance decreased in the pioglitazone group.

• Over median follow-up of 4.8 years, diabetes developed in 73 (3.8%) participants assigned to pioglitazone vs 149 (7.7%) in the placebo group (HR, 0.48).

Citation: Inzucchi SE, Viscoli CM, Young LH, et al. Pioglitazone prevents diabetes in insulin-resistant patients with cerebrovascular disease. [Published online head of print July 27, 2016]. Diabetes Care. doi:http://dx.doi.org/10.2337/dc16-0798.

Commentary: The data supporting the benefit of TZDs, particularly pioglitazone, continues to accumulate. The pioglitazone after ischemic stroke or transient ischemic attack trial showed a 25% decrease in the risk of recurrent stroke over approximately 5 years in patients with insulin resistance and a CVA or TIA.1 This is important because insulin resistance is present in over 50% of people without diabetes who have a stroke or a TIA.2 This study now shows a decrease of about 50% in the development of diabetes in this same group of people. Taking into account the side effects with pioglitazone of weight gain, edema and bone fracture, piogitazone may be a good choice to consider for selected patients with prediabetes who have had a stroke or TIA, with a goal of decreasing the risk of future stroke and diabetes. —Neil Skolnik, MD

1. Kernan WN, Viscoli KL, Furie, LH, et al. Pioglitazone after ischemic stroke or transient ischemic attack. [Published online ahead of print February 17, 2016]. N Engl J Med. doi:10.1056/NEJMoa1506930.

2. Kernan WN, Inzucchi SE, Viscoli CM, et al. Impaired insulin sensitivity among non- diabetic patients with a recent TIA or ischemic stroke. Neurology. 2003;60:1447-51. doi:http:/​/​dx.​doi.​org/​10.​1212/​01.​WNL.​0000063318.​66140.​A3.

This Week's Must Reads

Must Reads in Endocrinology