Pioglitazone increases risk of ischemic heart disease in patients with type 2 diabetes receiving insulin

• Published in: Journal of diabetes and its complications 2024-12, Vol.38 (12), p.108898, Article 108898
• Main Authors: Tsai, Ming-Hang, Chien, Wu-Chien, Lin, Hsin-Chung, Chung, Chi-Hsiang, Chen, Lih-Chyang, Huang, Kuo-Yang, Lin, Hsin-An
• Format: Article
• Language: English
• Subjects: Angina pectoris; Antidiabetics; Cardiovascular disease; Chronic illnesses; Comorbidity; Diabetes; Diabetes mellitus; Health risks; Heart attacks; Heart failure; Hospitals; Hyperlipidemia; Hypertension; Insulin; Insulin resistance; Ischemia; Ischemic heart disease; Kidney diseases; Mortality; Patients; Pharmacovigilance; Pioglitazone; Risk; Urbanization
• ISSN: 1056-8727; 1873-460X; 1873-460X
• DOI: 10.1016/j.jdiacomp.2024.108898

Studies evaluating the cardiovascular safety of pioglitazone show inconsistent results and ischemic heart disease (IHD) risks associated with different anti-diabetic drugs added to metformin uncontrolled type 2 diabetes mellitus (T2DM) are not assessed. This study aimed to evaluate IHD risk associated with pioglitazone and/or insulin added to patients with metformin uncontrolled T2DM. Data were extracted from the National Health Insurance Research Database of Taiwan. A total of 19,952 patients with T2DM uncontrolled on metformin received pioglitazone and/or insulin added to metformin were included. Compared to those who never received pioglitazone and/or insulin, patients receiving both insulin and pioglitazone had higher cumulative risk of IHD (adjusted HR [aHR] = 1.911, 95 % confidence interval [CI]: 1.506–2.351), pioglitazone alone (aHR = 1.446, 95 % CI: 1.111–1.775), and insulin alone (aHR = 1.351, 95 % CI: 1.1052–1.684) (all, p