Pioglitazone - Current status in the management of type 2 diabetes patients in India
Abstract
Diabetes is a major public health issue worldwide which is approaching epidemic proportions globally, including India. Among the proven pathophysiological factors for the development of type 2 diabetes, insulin resistance is the most common among Indian type 2 diabetes. Pioglitazone is currently most commonly prescribed either alone or in combination with other oral anti -hyperglycemic agents that target insulin resistance and improve insulin sensitivity among type 2 diabetes. The biggest controversy with pioglitazone for bladder cancer is over now. The major correlation between pioglitazone and bladder cancer is the duration of therapy > 24 months and cumulative dose of > 28000 mg which means the average daily dose of pioglitazone is about 40 mg/day. Dose dependent cumulative cancer by pioglitazone is also not possible in Indian patients because of low dose, i.e., 30 mg/day as a single dose is used unlike other countries 40 mg/day. To balance the pros and cons of pioglitazone use in Indian type 2 diabetes, the most suitable dose should be < 15 mg/day to gain significant glycemic control as determined by HbA1c along with better safety profile compared to higher dose prescription practice in Western countries. Current Indian data have been analyzed in this review article and it has been revealed that pioglitazone in lower dose of 7.5 mg/day offers similar HbA1c reduction property as moderate dose of 30 mg/day pioglitazone with lesser incidence of side effects. Therefore, to continue the benefits of pioglitazone in type 2 diabetes, prescription of low dose of pioglitazone is emerging trend in India.
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