Authors' objectives:

To provide guidance on the use of pioglitazone for type 2 diabetes mellitus.

Authors' recommendations: Guidance 1.1 Pioglitazone is effective at reducing blood glucose when added to oral monotherapy of either metformin or sulphonylurea for patients who have inadequate control of blood glucose on these agents alone. 1.2 Patients with inadequate blood glucose control on oral monotherapy (metformin or sulphonylurea) should first be offered metformin and sulphonylurea combination therapy, unless there are contraindications or tolerability problems. 1.3 Patients who are unable to take metformin and sulphonylurea combination therapy (either because of intolerance or contraindications to one of these drugs), or patients whose blood glucose remains high despite adequate trial of this combination, may be offered pioglitazone in combination with metformin or sulphonylurea as an alternative to injected insulin. 1.4 The combination of pioglitazone plus metformin is preferred to pioglitazone plus sulphonylurea, particularly for obese patients. Pioglitazone plus sulphonylurea may be offered to patients who show intolerance to metformin or for whom metformin is contraindicated. 1.5 As with any glucose-lowering medications, patients who are prescribed pioglitazone should be monitored against treatment targets for blood glucose and for other cardiovascular risk factors, including lipid profile. 1.6 Pioglitazone should be used in accordance with the manufacturer's recommendations. Presently these advise that liver function tests should be performed before initiation of therapy with pioglitazone, then every two months for the first twelve months after commencement of treatment, and periodically thereafter. Pioglitazone should not be used in patients with a history of cardiac failure, hepatic impairment or severe renal insufficiency. 1.7 Pioglitazone and rosiglitazone may be considered as alternatives.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nice.org.uk/cat.asp?c=15711

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: National Institute for Clinical Excellence

Contact Address: MidCity Place, 71 High Holborn, London WC1V 6NA, UK. Tel: +44 020 7067 5800; Fax: +44 020 7067 5801

Contact Name: nice@nice.nhs.uk

Contact Email: nice@nice.nhs.uk

Copyright: National Institute for Clinical Excellence (NICE)