Controversies of Pioglitazone in the Management of Diabetes Mellitus
Type II-diabetes mellitus (T2DM) is a chronic metabolic disorder which is treated with oral hypoglycaemic agents including pioglitazone. The present work is aimed to collect a brief profile of pioglitazone, belonging to the thiazolidinedione class and controversies surrounding its use. Pioglitazone which was marketed in 1999 acts on the nuclear peroxisome proliferator-activated receptor γ PPAR-γ in adipose tissue, skeletal muscles and liver. Pioglitazone is safe, potent, insulin sensitizing gene activator and regulate blood sugar level when administered orally alone or combination with sulphonyl ureas or metformin. India is one of the leading T2DM patients country and most patients are using pioglitazone because of its efficacy and economy. Even though it is a safe drug for diabetics, it was observed that it causes adverse effects like hepatotoxicity, cardiac failure, osteoporosis and urinary bladder cancer and hence pioglitazone was suspended in India in June 2013 for a brief duration by the Indian government. There are over 30 lakh people in India using this drug and there is no strong evidence to show that the drug has serious life threatening side effects in patients in India and also using Pioglitazone is less expensive than other drugs. By considering the safety, efficacy, potency and economy, health ministry of India revoked the earlier suspension on the diabetic patients and has allowed the manufacture and prescription of Pioglitazone and its formulation with several conditions. Hence, there is a lot of debate about benefit to risk ratio of this drug. Our study presenting brief information about pioglitazone and its controversies for diabetic mellitus in India.
T Balasubramanian*, M Karthikeyan, Sujith Puthanpurakkal
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