Insulin plus pioglitazone cuts all-cause and non-CV mortality

  • Yen FS & al.
  • J Clin Endocrinol Metab
  • 23 Sep 2019

  • International Clinical Digest
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Takeaway

  • Adding pioglitazone (Actos) to insulin is tied to reduced all-cause mortality and noncardiovascular (non-CV) deaths vs insulin alone.

Why this matters

  • Even with insulin, ~70% do not reach glycaemic targets.

Study design

  • Retrospective 13-year cohort study of insulin-using patients with T2D from a national Taiwanese health insurance database, with 2579 pioglitazone users matched to 2579 nonusers, all receiving insulin.  
  • Funding: Taiwan Ministry of Health and Welfare; Taipei Veterans General Hospital; China Medical University; others.

Key results

  • Mortality rates of pioglitazone users and nonusers were 15.02 and 30.26 per 1000 person-years, respectively; 
    • aHR, 0.47 (P<.001 for users vs nonusers.>
  • Incidence rates of non-CV death of pioglitazone users and nonusers:
    • 9.11 and 19.74 per 1000 person-years, respectively;
    • aHR, 0.50 (P<.001 for users vs nonusers.>
  • Incidence rates and aHRs of CV death (aHR, 0.78), heart failure (aHR, 0.99), hospitalized coronary artery disease (aHR, 0.84), and stroke (aHR, 0.99) between pioglitazone users and nonusers were not significantly different.

Limitations

  • No data on insulin or pioglitazone dose, adherence, hypoglycemia rates, or causes of death.
  • Possible residual confounding.