Renal function preservation with pioglitazone or with basal insulin as an add-on therapy for patients with type 2 diabetes mellitus

Abstract

Our study first showed that treatment with both pioglitazone and basal insulin improved glycemic control, while only pioglitazone treatment was observed to be advantageous in terms of preserving renal function when used as an add-on therapy for patients with type 2 DM in whom sulfonylurea and metformin regimens failed.

Effects of glucose-lowering agents on surrogate endpoints and hard clinical renal outcomes in patients with type 2 diabetes

“…In a US study within a real-life setting, initiation of insulin glargine compared with dulaglutide therapy was associated with a significantly greater decrease in eGFR after 1 year together with a smaller reduction in HbA1c [99]. Finally, in a study comparing basal insulin with pioglitazone as an add-on therapy for T2DM patients for whom sulphonylurea and metformin regimens had failed, both treatments improved glycaemic control, whereas only pioglitazone proved advantageous in terms of preserving renal function [58].…”

“…However, in patients with advanced diabetic nephropathy, no reduction in proteinuria was observed in patients treated with pioglitazone compared with glipizide for 4 months [57]. In a study that compared add-on pioglitazone with basal insulin, both treatments improved glycaemic control, but only pioglitazone was observed to be advantageous by preserving renal function when used as an add-on therapy for T2DM patients in whom sulphonylurea and metformin regimens had failed [58].…”

Safety and efficacy of antihyperglycaemic agents in diabetic kidney disease

“…43 Additionally to HbA1c reduction, TZDs may have a potential benefit preserving renal function in early stages of DKD and decreasing progression of albuminuria. 44,45 These ameliorating effects in DKD are considered to be independent of the achieved HbA1c and are thought to be secondary to decrease in oxidative stress and inflammation. 46 An advantage of TDZ drugs is that no dose adjustment is needed in the presence of advanced CKD or haemodialysis.…”

Renal Outcomes of Antidiabetic Treatment Options for Type 2 Diabetes—A Proposed MARE Definition

“…An additional study of interest compared pioglitazone with insulin detemir or glargine. 51 Overall, 1002 patients who showed inadequate responses to sulfonylurea or metformin received treatment escalation with 1 of the 3 medications. To ensure similar patient characteristics, 105 patients in each group were analyzed finally.…”

“…The probability of CKD progression was elevated in the detemir (HR = 2.63, 95% CI = 1.79−3.88) and glargine (HR = 3.13, 95% CI = 2.01−4.87) groups compared to pioglitazone, as determined by Cox regression. 51 …”