A wrapper with pills in it

Concerns about Actos

You may be considering pioglitazone or Actos to help treat your diabetes.  But you absolutely need to know that Actos has some very serious side effects and that it’s not entirely clear how well it works.

Pioglitazone, or Actos, is a very popular treatment for Type 2 Diabetes, with prescriptions counting for about 20-25% of total.  It works on peroxisome proliferator activated receptor-gamma receptors to improve sensitivity to insulin in various parts of the body.

The good thing is that Actos does have some benefits.  It seems to lower blood pressure, and seems to have a positive effect on certain important markers of health, like urine composition and levels of lipids in the blood.

And some studies like PROactive have shown that it has significant benefits in lowering risk of mortality from certain aspects of diabetes.

Concerns

First, the way that PROactive measured its outcomes was not properly done and changed in the middle of the study, almost certainly to make the medication come off as being better.  And most of the other studies don’t clearly show health benefits.

Yes, Actos or Pioglitazone does seem to have significant effect on certain physiological factors.  But those measures don’t necessarily translate to improved life-span or reduced risk of events.  And even the PROactive study didn’t have statistically different outcomes for certain serious diabetes related problems.

One analysis of 22 studies argued that 21 of them showed only improvement in surrogate measures.  That means that the medication was shown to have some sort of physical effect but not necessarily have health benefits.

Heart Failure

Worse.  Pioglitazone might significantly increase the risk of heart failure.  In one study, rate of heart failure went up from 2% to 4%, and in another from 8% to 11%.  This is despite having some effects that are good for the heart, like reducing thickness of certain arteries.

Actos also increases risk of bone fracture, and, like a related medication that was withdrawn from the market, may have significant liver toxicity.

Thoughts

Because of these factors, and the lack of definitive and convincing long-term studies focused on measuring health end-points, Pioglitazone’s cost-benefit analysis is not clear.  Its use over other options for Diabetes management should be very carefully considered.

Thanks for reading!

Mental Health - Alternative to Medication