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Reducing Diabetes Progression: Quiz


June 01, 2015

Which thiazolidinedione reduces risk of diabetes progression, stroke, and myocardial infarction in nondiabetic, insulin-resistant patients with a recent history of stroke?

a. rosiglitazone

b. pioglitazone

c. sulfonylurea

d. metformin

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Answer: b pioglitazone

The thiazolidinedione pioglitazone is a powerful dual treatment option for metabolic and cardiovascular diseases in non-diabetic patients with a history of stroke, according to Dr. Silvio E. Inzucchi, a professor of endocrinology at Yale School of Medicine. His recent study showed pioglitazone reduced risk of stroke and heart attack by 24% and cut progression to diabetes by 52% in nearly 4,000 non-diabetic, insulin-resistant patients who had recently suffered stroke or transient ischemic attack (TIA).

It was the first time a thiazolidinedione was shown to lower diabetes risk in patients with established cardiovascular disease and the only time a thiazolidinedione reduced both diabetes and cardiovascular complications in the same study, according to Dr. Silvio. He said the research provided undeniable evidence of the drug’s anti-atherosclerotic effects and proved that pioglitazone is the oral diabetes medication of choice for preventing cardiovascular events and diabetes progression.

Dr. Silvio said insulin resistance is very common after stroke and, after years of controversy surrounding the potential adverse cardiovascular effects of thiazolidinediones, the medical community needs to take a second look at pioglitazone — an old standby medication — to address both hyperglycemia and atherosclerosis. He said pioglitazone should be considered for high-risk patients who do not have contraindications such as heart failure.

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