title: Pioglitazone--do we really need it to manage type 2 diabetes?
abstract: Over the last few years a number of important drugs like rofecoxib, rosiglitazone, gatifloxacin (in diabetics) have lost their position in disease management. The newest controversy revolves around Pioglitazone, a thiozolidindione, which improves insulin sensitivity and is reputed to have cardioprotective actions, but is riddled with several controversies related to weight gain, distal fractures of long bones, recent reports of bladder cancer and others. There are now new groups of drugs, which have been introduced with stringent FDA approval. These include DPP-4 inhibitors, GLP-1 analogues and bromocriptine (old wine in a new bottle). Early in 2013 we are also looking at the launch of another new agent - SGLT-2 inhibitors. These newer agents are associated with not only a significant glucose lowering effect but also positive extra-glycaemic benefits principally in the areas of hypoglycaemia and weight gain. This raises a very important question - do we really need such a controversial agent when such a plethora of agents are available to us with possibly better metabolic profile than pioglitazone? This review addresses this highly contentious area dissecting the pros and cons as we see it.
authors.affiliation: AMRI Hospitals Salt Lake, Kolkata, India. Electronic address: binayaksinha@rediffmail.com.
authors.forename: Binayak
authors.initials: B
authors.lastname: Sinha
authors.forename: Samit
authors.initials: S
authors.lastname: Ghosal
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D061214:Patient Safety; D000077205:Pioglitazone; D018570:Risk Assessment; D045162:Thiazolidinediones / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000139:chemically induced; D015430:Weight Gain / Q000187:drug effects*
chemical_list: D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077205:Pioglitazone
keywords: Bladder cancer; Blood glucose; Fracture; Pioglitazone