Efficacy and Safety of Piolitazone Combined with Metformin in Type 2 Diabetes Mellitus: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 GAOQian , LIUXiao-Lan

Department of Endocrinology, Shaoxing Municipal Hospital, Shaoxing 312000, China;

Corresponding?author：

Keywords：

Piolitazone; Type 2 diabetes mellitus; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20160175

Video：

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Objective To evaluate the efficacy and safety of piolitazone combined with metformin for type 2 diabetes mellitus. Methods The Cochrane Library (Issue 9, 2015), PubMed, EMbase, CNKI, WanFang Data and VIP databases were searched up to September 2015 for randomized controlled trials (RCTs) about pioglitazone combined with metformin versus sulfonylurea combined with metformin for type 2 diabetes mellitus. Two reviewers independently screened literature, extracted date, and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 7 RCTs involving 3 005 patients were included. The results of metaanalysis showed that when the course of treatment was ≤24 weeks, no significant difference was found in the level of HbA1c between the piolitazone plus metformin group and the sulphonylurea plus metformin group (MD=-0.04, 95%CI -0.26 to 0.19, P=0.74), but the piolitazone plus metformin group had lower risk of hypoglycemia (RR=0.39, 95%CI 0.15 to 1.01, P=0.05); when the course of treatment >24 weeks, only one RCT was included, we didn't conduct pool analysis. Conclusion Piolitazone combined with metformin has similar effect to sulphonylurea combined with metformin in controlling blood sugar, but piolitazone combined with metformin has lower incidence of hypoglycemia. Due to limited quality and quantity of the included studies, the above conclusion need to be verified by more high quality studies.

Citation： GAOQian, LIUXiao-Lan. Efficacy and Safety of Piolitazone Combined with Metformin in Type 2 Diabetes Mellitus: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(10): 1148-1153. doi: 10.7507/1672-2531.20160175 Copy

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7.	Charbonnel B, Schernthaner G, Brunetti P, et al. Long-term efficacy and tolerability of add-on pioglitazone therapy to failing monotherapy compared with addition of gliclazide or metformin in patients with type 2 diabetes. Diabetologia, 2005, 48(6): 1093-1104.
8.	Sch?ndorf T, Musholt PB, Hohberg C, et al. The fixed combination of pioglitazone and metformin improves biomarkers of platelet function and chronic inflammation in type 2 diabetes patients: Results from the PIOfIx study. J of Diabetes Sci and Tech, 2011, 5(2): 426-432.
9.	Pfutzner A, Schondorf T, Tschope D, et al. PIOfix-study: effects of pioglitazone/metformin fixed combination in comparison with a combination of metformin with glimepiride on diabetic dyslipidemia. Diabetes Tech & Thera, 2011, 13(6): 637-643.
10.	Matthews DR, Charbonnel BH, Hanefeld M, et al. Long-term therapy with addition of pioglitazone to metformin compared with the addition of gliclazide to metformin in patients with type 2 diabetes: a randomized, comparative study. Diabetes/Metabolism Res and Rev, 2005, 21(2): 167-174.
11.	Karamanos B, Thanopoulou A, Drossinos V, et al. Study comparing the effect of pioglitazone in combination with either metformin or sulphonylureas on lipid profile and glycaemic control in patients with type 2 diabetes (ECLA). Cur Med Res and Opin, 2011, 27(2): 303-313.
12.	寧建霞. 二甲雙胍聯用鹽酸吡格列酮治療2型糖尿病的療效觀察. 基層醫學論壇, 2008, 12(35): 1107-1108.
13.	張莉. 吡格列酮聯用二甲雙胍治療2型糖尿病療效觀察. 中國社區醫師: 醫學專業, 2011, 19(13): 40-41.
14.	施利群, 邱斌, 徐建如. 二甲雙胍聯合吡格列酮對2型糖尿病患者血糖?高敏C反應蛋白的影響. 中華實用診斷與治療雜志, 2010, 24(8): 804-805.
15.	Schernthaner G, Currie CJ, Schernthaner GH. Do we still need pioglitazone for the treatment of type 2 diabetes? A risk-benefit critique in 2013. Diabetes Care, 2013, 36 Suppl 2: S155-161.
16.	Rojas LB, Gomes MB. Metformin: an old but still the best treatment for type 2 diabetes. Diabetology & Metabolic Syndrome, 2013, 5(1): 6-21.
17.	Krentz AJ, Bailey CJ. Oral antidiabetic agents: current role in type 2 diabetes mellitus. Drugs, 2005, 65(3): 385-411.
18.	Erdmann E, Spanheimer R, Charbonnel B. Pioglitazone and the risk of cardiovascular events in patients with Type 2 diabetes receiving concomitant treatment with nitrates, renin-angiotensin system blockers, or insulin: results from the PROactive study (PROactive 20). J of Diabetes, 2010, 2(3): 212-220.
19.	Billington EO, Grey A, Bolland MJ. The effect of thiazolidinediones on bone mineral density and bone turnover: systematic review and Meta-analysis. Diabetologia, 2015, 58(10): 2238-2246.
20.	Bosetti C, Rosato V, Buniato D, et al. Cancer risk for patients using thiazolidinediones for type 2 diabetes: a Meta-analysis. The Oncologist, 2013, 18(2): 148-156.
21.	張俊英, 馬彬, 楊克虎, 等. 二甲雙胍和羅格列酮聯用治療2型糖尿病的系統評價. 中國循證醫學雜志, 2009, 9(4): 437-445.
22.	張質鋼, 王小虎, 張秋寧. 國內系統評價納入標準對隨機試驗的界定差異有可能導致偏倚. 中國循證醫學雜志, 2013, 13(6): 764-767.

1. 中華醫學會糖尿病學分會. 中國2型糖尿病防治指南(2013年版). 中國糖尿病雜志, 2014, 8(22): 2-42.
2. International Diabetes Federation (2005): Global Guidelines for type 2 diabetes. Available at: http://www.idf.org/webdata/docs/GGT2D%2009%20Oral%20therapy.pdf..
3. Diamant M, Heine RJ. Thiazolidinediones in type 2 diabetes mellitus: current clinical evidence. Drugs, 2003, 63(13): 1373-1405.
4. Pittas AG, Greenberg AS. Thiazolidinediones in the treatment of type 2 diabetes. Expert Opinion on Pharm, 2002, 3(5): 529-540.
5. Higgins JP, Altman DG. Chapter8: Assessing risk of bias in included studies. Cochrane handbook for systematic reviews of interventions version 5.1.0 (updatedsep 2011). The Cochrane Collaboration, 2011.
6. Betteridge DJ, Verges B. Long-term effects on lipids and lipoproteins of pioglitazone versus gliclazide addition to metformin and pioglitazone versus metformin addition to sulphonylurea in the treatment of type 2 diabetes. Diabetologia, 2005, 48(12): 2477-2481.
7. Charbonnel B, Schernthaner G, Brunetti P, et al. Long-term efficacy and tolerability of add-on pioglitazone therapy to failing monotherapy compared with addition of gliclazide or metformin in patients with type 2 diabetes. Diabetologia, 2005, 48(6): 1093-1104.
8. Sch?ndorf T, Musholt PB, Hohberg C, et al. The fixed combination of pioglitazone and metformin improves biomarkers of platelet function and chronic inflammation in type 2 diabetes patients: Results from the PIOfIx study. J of Diabetes Sci and Tech, 2011, 5(2): 426-432.
9. Pfutzner A, Schondorf T, Tschope D, et al. PIOfix-study: effects of pioglitazone/metformin fixed combination in comparison with a combination of metformin with glimepiride on diabetic dyslipidemia. Diabetes Tech & Thera, 2011, 13(6): 637-643.
10. Matthews DR, Charbonnel BH, Hanefeld M, et al. Long-term therapy with addition of pioglitazone to metformin compared with the addition of gliclazide to metformin in patients with type 2 diabetes: a randomized, comparative study. Diabetes/Metabolism Res and Rev, 2005, 21(2): 167-174.
11. Karamanos B, Thanopoulou A, Drossinos V, et al. Study comparing the effect of pioglitazone in combination with either metformin or sulphonylureas on lipid profile and glycaemic control in patients with type 2 diabetes (ECLA). Cur Med Res and Opin, 2011, 27(2): 303-313.
12. 寧建霞. 二甲雙胍聯用鹽酸吡格列酮治療2型糖尿病的療效觀察. 基層醫學論壇, 2008, 12(35): 1107-1108.
13. 張莉. 吡格列酮聯用二甲雙胍治療2型糖尿病療效觀察. 中國社區醫師: 醫學專業, 2011, 19(13): 40-41.
14. 施利群, 邱斌, 徐建如. 二甲雙胍聯合吡格列酮對2型糖尿病患者血糖?高敏C反應蛋白的影響. 中華實用診斷與治療雜志, 2010, 24(8): 804-805.
15. Schernthaner G, Currie CJ, Schernthaner GH. Do we still need pioglitazone for the treatment of type 2 diabetes? A risk-benefit critique in 2013. Diabetes Care, 2013, 36 Suppl 2: S155-161.
16. Rojas LB, Gomes MB. Metformin: an old but still the best treatment for type 2 diabetes. Diabetology & Metabolic Syndrome, 2013, 5(1): 6-21.
17. Krentz AJ, Bailey CJ. Oral antidiabetic agents: current role in type 2 diabetes mellitus. Drugs, 2005, 65(3): 385-411.
18. Erdmann E, Spanheimer R, Charbonnel B. Pioglitazone and the risk of cardiovascular events in patients with Type 2 diabetes receiving concomitant treatment with nitrates, renin-angiotensin system blockers, or insulin: results from the PROactive study (PROactive 20). J of Diabetes, 2010, 2(3): 212-220.
19. Billington EO, Grey A, Bolland MJ. The effect of thiazolidinediones on bone mineral density and bone turnover: systematic review and Meta-analysis. Diabetologia, 2015, 58(10): 2238-2246.
20. Bosetti C, Rosato V, Buniato D, et al. Cancer risk for patients using thiazolidinediones for type 2 diabetes: a Meta-analysis. The Oncologist, 2013, 18(2): 148-156.
21. 張俊英, 馬彬, 楊克虎, 等. 二甲雙胍和羅格列酮聯用治療2型糖尿病的系統評價. 中國循證醫學雜志, 2009, 9(4): 437-445.
22. 張質鋼, 王小虎, 張秋寧. 國內系統評價納入標準對隨機試驗的界定差異有可能導致偏倚. 中國循證醫學雜志, 2013, 13(6): 764-767.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Piolitazone Combined with Metformin in Type 2 Diabetes Mellitus: A Meta-analysis

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