T2D with CKD: low-dose pioglitazone retains benefits, reduces side effects

  • Satirapoj B & al.
  • PLoS ONE
  • 1 Jan 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Low-dose pioglitazone (e.g., Actos) offers similar efficacy but reduced weight gain and fluid retention vs standard dose in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD).

Why this matters

  • Comorbid CKD limits choice of hypoglycemic agents.
  • Weight gain, fluid retention remain issues with pioglitazone.

Study design

  • 24-week randomized controlled trial, 75 patients (mean age, 62.2±10.6 years) with CKD and inadequately controlled T2D, assigned to standard-dose (15 mg/day) or low-dose pioglitazone (7.5 mg/day).
  • Main CKD stages were II (30.7%), III (37.3%), and IV (25.3%).
  • Funding: Phramongkutklao Hospital and College of Medicine; National Science and Technology Development Agency, Thailand.

Key results

  • Results at 6 months showed similarly significant reductions in HbA1c levels with standard- and low-dose pioglitazone (mean Δ, –1.4±1.5% vs –1.1±1.6%; P=.54).
  • Compared with standard-dose, low-dose pioglitazone led to less (P<.05 increase in: style="list-style-type:circle;">
  • Body weight (0.2±4.4 vs 3.5±3.2 kg: mean Δ, 3.3 kg; 95% CI, 1.3-5.2 kg).
  • Fat mass (0.7±3.6 vs 2.9±3.7 kg: mean Δ, 2.2 kg; 95% CI, 0.2-4.1 kg).
  • Total body water (−0.6±1.7 vs 1.1±1.9 L: mean Δ, 0.7 L; 95% CI, 0.3-2.2 L).
  • Extracellular water (–0.3±0.8 vs 0.5±0.9 L: mean Δ, 0.4 L; 95% CI, 0.1-1.1 L).
  • No major adverse events reported.
  • Limitations

    • Short-term data.
    • Small sample.

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