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Pioglitazone improves outcomes in patients with diabetes, study shows

By Daniel Cressey

Glitazone treatment can substantially cut deaths, heart attacks and strokes in patients with type 2 diabetes, a major new international trial concludes.

The Proactive study, published in The Lancet this week, found use of pioglitazone reduced the combined endpoint of death, myocardial infarction or stroke by 15 per cent.

The researchers called for NICE to re-assess glitazone use in light of the ‘really quite remarkable' results.

GPs said NICE guidance was ‘outdated' in restricting use of glitazones second-line to patients intolerant of metformin or sulphonylureas in combination.

The trial, including 5,238 patients with type 2 diabetes and evidence of macrovascular disease, also found pioglitazone improved glycaemic control, reducing HbA1C levels by 0.8 per cent.

Professor John Dormandy, chair of the Proactive steering committee, told Pulse: ‘NICE and other regulatory authorities should look at pioglitazone again in the light of this study.'

Professor Dormandy, professor of vascular sciences at St George's Hospital, London, said the results would be widely applicable. ‘I would expect pioglitazone ought to work at least as well in other type 2 diabetics.'

Dr Colin Kenny, chair of the Primary Care Diabetes Society and a GP in Co Down, Northern Ireland, said: ‘It is gratifying to know glitazones do not adversely affect CV risk and seem to improve outcomes. I suspect given this, future studies and the drive to achieve targets, these agents will be used outside NICE guidance.'

Dr Neil Munroe, a GP in Surrey and associate specialist in diabetes at Chelsea and Westminster hospital, London, said he believed the study would result in increased use of glitazones in selected patients. ‘The NICE guidelines do seem dated,' he added.

But Dr Martin Hadley-Brown, a GP in Thetford, Norfolk, and member of the professional advisory council of Diabetes UK, cautioned the results might not be widely applicable. He added: ‘The reductions they showed were not as great as many of us had hoped for.'

NICE said its review date was currently July 2006 but that ‘there is provision in our process to bring forward that date'. The study was funded by Takeda Pharmaceutical Company and Eli Lilly.

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