Effect of combination pioglitazone with sodium‐glucose cotransporter‐2 inhibitors or glucagon‐like peptide ‐1 receptor agonists on outcomes in type 2 diabetes: A systematic review, meta‐analysis, and real‐world study from an international federated database
Authors' conclusion
Both our systematic review/meta-analysis and the real-world dataset show that combination of pioglitazone with either GLP-1RAs or SGLT2 inhibitors is associated with increased weight loss and reduced risk of heart failure compared with monotherapy.
Study context
- Population
- Adults with T2D; trials with follow-up 24 to 52 weeks; real-world cohort of individuals aged ≥18 years treated ≥1 year (TriNetX)19 studies · 16 RCTs
- Comparison
- Pioglitazone + GLP-1 RA or pioglitazone + SGLT2i vs controls
- Outcome
- HbA1c, weight, systolic blood pressure (SBP) and mortality vs controls (meta-analysis)
- Follow-up
- 24 to 52 weeks
Methodological detailspropensity-score-matched real-world cohort (TriNetX), GRADE
- Propensity-score-matched real-world cohort (TriNetX)
- GRADE
Pooled result
As reported in the abstract
Each group vs controlsMean difference (HbA1c), % (95% CI)
Pioglitazone + GLP-1RAHbA1c reduced greater than in controls
−1(−1.27 to −0.74)
Pioglitazone + SGLT2 inhibitorsreduced to a greater extent than control treatment
−0.48(−0.67 to −0.28)
Each group vs controlsMean difference (weight), kg (95% CI)
Pioglitazone + GLP-1RAweight reduced greater than in controls
−1.19(−1.80 to −0.58)
Pioglitazone + SGLT2 inhibitorsreduced to a greater extent than control treatment
−2.3(−2.72 to −1.88)
Each group vs controlsMean difference (SBP), mmHg (95% CI)P value
Pioglitazone + GLP-1RA
- 1.56(−4.48 to 1.35)
P = 0.30Pioglitazone + SGLT2 inhibitorsreduced to a greater extent than control treatment
−2.4(−4.1 to −0.7)
P = 0.01Each group vs controlsRelative risk (mortality) (95% CI)P value
Pioglitazone + GLP-1RA
0.29(0.07–1.15)
P = 0.08- Mortality, pioglitazone + SGLT2 inhibitors vs controls: no statistically significant difference (RR 1.81, 95% CI 0.30-10.97)
- P = 0.52
Further pooled results
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| HF, real-world cohortPioglitazone + SGLT2ivs Controlsvs SGLT2i monotherapy; n = 25 230 identified · propensity-score-matched | 0.50 (0.38–0.65) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
Original publication
Effect of combination pioglitazone with sodium‐glucose cotransporter‐2 inhibitors or glucagon‐like peptide ‐1 receptor agonists on outcomes in type 2 diabetes: A systematic review, meta‐analysis, and real‐world study from an international federated database. Diabetes Obes Metab. Published 1 April 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →