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Pioglitazone reduces progression to diabetes in people with cerebrovascular disease

The recent IRIS (Insulin Resistance Intervention after Stroke) trial has discovered that pioglitazone reduced the risk of fatal and non-fatal stroke and myocardial infarction in people with cerebrovascular disease who were insulin resistant. The study also found that pioglitazone significantly reduced the progression to diabetes in this group.

By Colin Kenny, GP, Dromore

This IRIS trial included 3876 patients who had recently had a stroke or heart attack and who were insulin resistant. They were randomly assigned to pioglitazone 45 mg or placebo. They were assessed annually through interviews and fasting plasma glucose (FPG) testing. During 4.8 years of follow-up, 73 people (3.8%) in the pioglitazone group developed type 2 diabetes, compared with 149 (7.7%) in the placebo group

The greatest reduction in risk occurred in people who had impaired baseline FPG or an elevated HbA1c level (>39 mmol/mol [5.7%]). Among people who did not have diabetes but who were insulin-resistant and had had a recent ischaemic stroke or transient ischaemic attack, pioglitazone decreased the risk of diabetes while also reducing the risk of subsequent ischaemic events. Pioglitazone is the first medication shown to prevent both progression to diabetes and major cardiovascular events as pre-specified outcomes in a single trial.

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