Pioglitazona en el control glucémico, perfil lipídico y riesgo cardiovascular: revisión actualizada sobre sus beneficios y datos emergentes sobre su seguridad

Abstract

Currently, pioglitazone is the only thiazolidinedione still available for use in Europe. This compound enhances insulin sensitivity and improves lipid metabolism activating «peroxisome proliferator-activated receptors» (PPAR), these aspects are key factors in the current treatment of diabetes mellitus. This antihyperglycemic effect and its improvements on lipid metabolism, has been confirmed in randomized, comparative clinical trials, which have demonstrated the efficacy of pioglitazone as monotherapy or in combination with other antidiabetic agents. Their impact on cardiovascular risk is particularly important; pioglitazone induces favorable changes in triglyceride and HDL-cholesterol and anti-atherogenic effect. Adverse effects associated with the use of pioglitazone are usually mild and manageable. In susceptible patients, some potentially serious adverse effects may require special precautions. For instance, heart failure or bladder cancer, although the latter has yet to be confirmed. In conclusion, pioglitazone has a clinically significant antihyperglycemic effect without increased risk of hypoglycemia, with greater potential benefit for patients with predominantly insulin resistance, and a potential association to with cardiovascular protection. Taking into account its safety profile with adverse effects generally mild and manageable, confirms that the benefit-risk balance of pioglitazone remains positive.