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Managing Diabetes and Prediabetes
Published in Ruth Chambers, Paula Stather, Tackling Obesity and Overweight Matters in Health and Social Care, 2022
The ideal drug to manage type 2 diabetes should encourage weight loss and not cause hypoglycaemia. Here are a few examples: Metformin. This low-cost drug has been available in the UK for over 60 years and remains the preferred first choice for newly diagnosed patients with type 2 diabetes.Glucagon-linked peptide (GLP) 1 analogue. These injections can be administered twice a day, once a day or once a week.Sodium glucose co-transporter 2(SGLT2) inhibitor works by preventing the kidneys from reabsorbing glucose back into the blood. Sulfonylureas and insulin commonly cause weight gain, and weight gain is a recognised side effect of pioglitazone. Dipeptidyl peptidase-4 (DPP4) inhibitors are weight neutral.
Cancer
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
The exact cause of bladder cancer is unknown. The risk factors of bladder cancer increase with cigarette smoking. They are also higher with exposure to aniline dyes, beta naphthylamine, mixtures of aromatic hydrocarbons, or benzidine, as used in chemical, paint, plastics, textile, petroleum, and wood industries. Other predisposing factors are chronic urinary tract infections, calculous disease, and schistosomiasis. Adenocarcinomas are caused by extensive intestinal metaplasia known as cystitis glandularis, usually occurring at the trigone. Etiology may be related to exstrophy of bladder. The diverticula sometimes develop adenocarcinomas. Other causes are endometriosis, pelvic lipomatosis, and infection with Schistosoma haematobium. The link between diabetes and bladder cancer mostly concerns use of the diabetes drug pioglitazone (Actos) for 2 years or more. The drug is used to control high blood glucose levels in type 2 diabetes. It is also sold in combination with metformin (as Actoplus Met or Actoplus Met XR) and with glimepiride (Duetact). In the United States, the Food and Drug Administration recommends that pioglitazone not be used in patients with active bladder cancer. It should be used with caution in patients with a previous history of bladder cancer.
Pharmacological Management of Alzheimer’s Disease
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Rakesh Kumar, Rajan Kumar, Abhinav Anand, Neha Sharma, Navneet Khurana
The main use of pioglitazone is as a remedy for type 2 diabetes. It acts via receptor nuclear PPARγ. It attaches and forms a heterodimer with retinoid X receptor (RXR), which further leads to the alteration of the transcription of the gene and proteins related to the glucose and lipid metabolism (Application, 2013). Now it was reported that PPARγ is also involved in the neuroinflammation of the AD. Rosiglitazone is one of first PPARγ compound which was tested in the AD and entered in phase III of the clinical trials but later abandoned. Later on, pioglitazone was reported to reduce the glial cell inflammation and Aβ level in transgenic mice (Harrington et al., 2011).
Inflammatory myopathies: shedding light on promising agents and combination therapies in clinical trials
Published in Expert Opinion on Investigational Drugs, 2021
Rachel Zeng, Stefanie Glaubitz, Jens Schmidt
Another way for the reduction of cell stress in IBM is the improvement of mitochondrial dysfunction. A potential agent with this respect is pioglitazone. To investigate the effect of pioglitazone in skeletal muscles of IBM patients, a single center, open-label, phase 1 study was conducted in 19 IBM patients. The study included a screening period followed by a 16-week phase without treatment, followed by a low dose treatment with pioglitazone and finally a 32-week treatment period with pioglitazone in a higher dosage of 45 weeks. The primary outcome was the change in Peroxisome proliferator-activated receptor gamma coactivator 1-alpha target gene expression in comparison to the baseline expression. The study is completed and results are expected soon [ClinicalTrials.gov Identifier: NCT03440034].
Are thiazolidinediones a preferred drug treatment for type 2 diabetes?
Published in Expert Opinion on Pharmacotherapy, 2021
Kathryn M. Hurren, Marissa Waldman Dunham
After metformin, SGLT2 inhibitors and/or GLP-1RAs should be favored for most patients with T2DM, especially those with coexisting established or high risk for ASCVD, CKD, HF, and/or obesity. Other than these classes, pioglitazone is the only agent associated with possible ASCVD benefit. TZDs likely have greater efficacy compared to DPP4 inhibitors but are associated with more adverse effects. Pioglitazone has minimal risk of hypoglycemia, which is a considerable advantage over sulfonylureas and insulin. It is also a cost-effective option, though it is important to consider all anticipated healthcare costs associated with therapy rather than medication cost alone. As pioglitazone should be avoided in patients with HF, risk factors for edema (including insulin use), and risk for fractures, its place in therapy has become relatively restricted. In summary, pioglitazone is a glucose-lowering agent with a unique mechanism of action resulting in benefits beyond glucose-lowering, which are balanced by considerable risks. Pioglitazone may be considered as a fourth-line, non-insulin option after metformin, SGLT-2 inhibitor, and GLP1-RA in patients with ASCVD who are not at risk for adverse effects or sooner if other therapies are contraindicated, not tolerated, or cost-prohibitive. In patients without ASCVD, HF or CKD, pioglitazone should be considered as second-line therapy with appropriate monitoring for adverse effects.
Efficacy and safety of pioglitazone for treatment of plaque psoriasis: a systematic review and meta-analysis of randomized controlled trials
Published in Journal of Dermatological Treatment, 2020
Guizhen Chang, Jin Wang, Jingxin Song, Zhilong Zhang, Litao Zhang
Among the TZDs, which consist of pioglitazone, rosiglitazone, and troglitazone, troglitazone has been withdrawn for its potential severe hepatotoxicity. However, the other two members of this family have proven to be safe and with a favorable side effect profile. A meta-analysis (4) has reported the effectiveness of TZD for plaque psoriasis, in which two studies each for pioglitazone and rosiglitazone were included (5–8). In the review, it reported that there was a significantly greater mean decrease in PASI scores from baseline at the end of treatment in the pioglitazone group as compared to placebo, but not in the rosiglitazone group as compared to placebo (4). Pioglitazone is a TZD with no serious side effects associated with short term use and with reassuring effects on the outcome of the treatment. Several placebo-controlled randomized trials showed that pioglitazone did have some side effects. The adverse effects of pioglitazone include: a moderate increase in hepatic transaminase levels, weight gain due to fluid retention, nausea, edema, anemia, and heartburn (5,9–12).