As a follow up to last Thursday's rant about magic pill(s) to prevent diabetes, I wanted to delve further into exploring the risks associated with pioglitazone, especially since it's pharmaceutical competitor, rosiglitazone, has been linked to increase risk of adverse cardiac events (both are known to increase one's risk for heart failure exacerbations plus both are linked to greater fracture risk) and an earlier version, troglitazone, was pulled off the market due to risk of liver issues.
Now, medically speaking, I tend to lump things together, rather than split them apart. Of course, the pharmaceutical companies don't like this as they want their product to stand out as superior to the rest. But given a number of otherwise similar products, I tend to choose the least expensive, generic version that gives me equivalent results.
But let's think about this the other way around. Let's say that there are 2 drugs, neither one of which is risk-free, sharing some side effects in common (weight gain, edema, heart failure, and fracture risk), but one of which has a significantly greater risk of say bad cardiac outcomes. While it has not been been demonstrated via randomized, double blind, placebo controlled studies, let's say for arguments sake that all the observational data point toward a significant difference in terms of these cardiac outcomes. Given this summary, wouldn't you split, rather than lump, and choose the drug with the lower risk profile?
As if you couldn't tell, I was referring to pioglitazone & rosiglitazone. And in a quirk of fate or perhaps just serendipity, a systematic review & meta-analysis of 16 observational studies involving over 810,000 uses of TZDs (both pioglitazone & rosiglitazone) was just published in the British Medical Journal concluding that the latter drug was associated with a statistically significant greater risk for heart attacks, heart failure & mortality, compared to those who received the former.
So if you're looking for a magic pill w/o side effects that will prevent diabetes, keep looking. It doesn't exist yet. But if lifestyle modification isn't in the books for you, last Thursday's review offers hope with pioglitazone assuming that you are not risk adverse. But in one of those rare situations, I wouldn't substitute its competitor, rosiglitazone, even if it were offered to me for free.