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Pioglitazone in the management of Type 2 diabetes and beyond

Harald Sourij and Thomas C Wascher

The prevalence of Type 2 diabetes mellitus is increasing rapidly and this disease has become an alarming healthcare problem in recent years. Both insulin resistance and β-cell dysfunction play important roles in the pathophysiology of Type 2 diabetes mellitus. Pioglitazone, a thiazolidinedione, has been demonstrated to improve both impairments and is currently used as monotherapy or in combination with insulin, sulfonylureas or metformin for the treatment of Type 2 diabetes mellitus. Clinical studies have confirmed the efficacy, safety and tolerability profile of pioglitazone and, furthermore, a large outcomes trial has recently demonstrated positive cardiovascular effects. Ongoing studies have shown that pioglitazone has possible applications beyond the treatment of diabetes in conditions such as nonalcoholic steatohepatitis or polycystic ovarian syndrome. This review provides an overview of the pharmacology, clinical efficacy and safety of pioglitazone, focusing primarily on the most recent data.