title: The Influences of Withdrawal and Daily Dose Reduction of Pioglitazone on Metabolic Parameters in Patients With Type 2 Diabetes: A Retrospective Longitudinal Observational Study.
abstract: BACKGROUND
  The aim of the study was to understand the influences of withdrawal or dose reduction of pioglitazone in patients with type 2 diabetes.
  
  
  METHODS
  We retrospectively picked up patients who had undergone withdrawal or daily dose reduction of pioglitazone after a continuous prescription for 3 months or longer between January 2010 and March 2014. We compared the data before the withdrawal or dose reduction of pioglitazone with the data at 3 or 6 months after those by a chart-based analysis.
  
  
  RESULTS
  Among 713 patients taking pioglitazone at least once during the studied period, 20 patients had undergone withdrawal of pioglitazone (group A) and 51 patients had undergone daily dose reduction (group B). The mean pioglitazone dose at baseline was 23 mg in subjects of group A, and 30 mg in group B. The number of subjects who had taken high-dose metformin (≥ 1,000 mg) and dipeptidyl peptidase-4 (DPP-4) inhibitors increased after the withdrawal or dose reduction of pioglitazone in both groups. Although no significant change was observed in plasma glucose and HbA1c levels, body weight significantly decreased at 3 and 6 months after the dose reduction in group B. The same tendency was observed in group A. Serum high-density lipoprotein-cholesterol (HDL-C) levels significantly decreased at 3 and 6 months after the withdrawal in group A. The serum alanine aminotransferase levels significantly increased 3 months after the withdrawal in group A.
  
  
  CONCLUSIONS
  Present study demonstrated that the withdrawal of pioglitazone exacerbated serum HDL-C and liver function in patients with type 2 diabetes, although glycemic control could be maintained by using high-dose metformin or DPP-4 inhibitors.
authors.affiliation: Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan.
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Katsuyama
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Fukunaga
authors.affiliation: Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Hamasaki
authors.affiliation: Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Adachi
authors.affiliation: Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan.
authors.forename: Sumie
authors.initials: S
authors.lastname: Moriyama
authors.affiliation: Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Kawaguchi
authors.affiliation: Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Mishima
authors.affiliation: Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan.
authors.forename: Akahito
authors.initials: A
authors.lastname: Sako
authors.affiliation: Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan.
authors.forename: Hidekatsu
authors.initials: H
authors.lastname: Yanai
keywords: Body weight; HDL-cholesterol; Liver function; Pioglitazone; Withdrawal