Scientists from the University at Buffalo found that an insulin-sensitizing drug can benefit patients with insulin resistance at lower doses than has typically been prescribed.
The study shows that low doses of pioglitazone used to treat diabetes in patients with insulin resistance may be preferable.
The research is published in Diabetes, Obesity and Metabolism and was conducted by Paresh Dandona et al.
Pioglitazone is a potent insulin-sensitizing drug with anti-atherosclerotic properties, but adverse effects of weight gain and edema have limited its use.
In this study, patients had a history of previous stroke or transient ischemic attack (TIA).
The researchers assessed the benefits and risks of lower versus higher doses of pioglitazone taken by participants in a secondary prevention trial who had a history of stroke.
Insulin resistance is a common condition that is closely related to older age, increasing weight and genetic predisposition. And it affects the majority of patients with Type 2 diabetes.
Insulin resistance is also an established independent risk factor for vascular disease, including stroke and myocardial infarction, and partly explains the association between diabetes and increased risk for these diseases.
The team says pioglitazone is currently used to treat patients with Type 2 diabetes.
The most recent American Heart Association/American Stroke Association guidelines on secondary stroke prevention list the drug as a Class 2B recommendation in patients with stroke who have insulin resistance and elevated glycated hemoglobin.
The team says this recommendation stems directly from the findings of the Insulin Resistance Intervention in Stroke (IRIS) trial.
They instigated the reanalysis of the IRIS study because he has been prescribing pioglitazone over the past decade at a low dose of 15 milligrams with excellent results of glycemic control without the side effects of weight gain and edema.
The IRIS study demonstrated that pioglitazone not only reduced the heart complications, but also reduced the progression of prediabetes to diabetes.
Furthermore, since pioglitazone is a generic drug, it is inexpensive compared to insulin.
The team says pioglitazone must be used prior to insulin, especially since subcutaneously injected insulin has no protective effect on cardiovascular complications.
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