Safety and Efficacy of Low Dose (7.5 mg) as Compared to Standard Dose (15 mg) Pioglitazone in Type 2 Diabetes and Metabolic Syndrome: A Systematic Review and Meta-analysis.

Authors

Deep Dutta, Kunal Mahajan, Sweekruti Jena, Ameya Joshi, Meha Sharma, Ritin Mohindra, Vineet Surana, Saptarshi Bhattacharya

Published in

Annals of African medicine. Oct 07, 2026. Epub Oct 07, 2026.

Abstract

Weight gain and fluid retention with pioglitazone appear dose-dependent, and South/East Asian populations may retain glycemic benefit at lower doses. This systematic review and meta-analysis compared low-dose pioglitazone (LDP, 7.5 mg/day) with standard-dose pioglitazone (15 mg/day) - and secondarily with 30 mg/day and placebo - in type-2 diabetes (T2D) and metabolic syndrome (MetS).
PubMed, Embase, and Cochrane Library were searched for studies of T2D and/or MetS patients receiving pioglitazone 7.5 mg/day versus 15/30 mg/day or placebo. Primary outcomes were change in body weight and body mass index (BMI); secondary outcomes were edema, glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), lipids, and liver enzymes. Random-effects (inverse-variance) models were used; heterogeneity was assessed with I2 and prediction intervals (PI). Risk of bias was assessed using RoB2 and ROB In Non-randomized Studies-of Interventions.
Twelve studies were included. Versus 15 mg/day, 7.5 mg/day produced significantly less weight gain (mean difference [MD]: -1.61 kg [95% confidence interval: -2.13, -1.08]; P < 0.001; I2 = 56%; PI: -2.66, -0.55) and a smaller BMI rise (MD - 0.47 kg/m2 [-0.68, -0.26]; P < 0.001; I2 = 18%; PI: -0.78, -0.16), both robust on PI analysis. HbA1c was comparable at 3 months (MD 0.08% [-0.18, 0.34]; P = 0.53) and 6 months (MD 0.18% [-0.05, 0.42]; P = 0.13). Edema was lower with 7.5 mg/day but only borderline (odds ratios 0.19 [0.04, 0.99]; P = 0.05; I2 = 71%) and non-significant on PI analysis. FPG was similar at 3 months but modestly higher with 7.5 mg/day at 6 months (MD 7.71 mg/dl [1.64, 13.78]; P = 0.01), a difference not retained on PI analysis. Low-density lipoprotein-cholesterol and triglycerides were comparable; high-density lipoprotein-cholesterol (HDL-C) was marginally lower with 7.5 mg/day (MD: -2.11 mg/dl [-2.47, -1.75]). Weight and BMI advantages were also seen versus 30 mg/day, with comparable HbA1c. No formal non-inferiority margin was prespecified.
LDP (7.5 mg/day) offers HbA1c control comparable to 15 mg/day with less weight and BMI gain, supporting it as a candidate minimum effective dose. A modest 6-month FPG difference, slightly lower HDL-C, and predominantly ≤6-month follow-up warrant confirmation in longer trials.

PMID:
42844881
Bibliographic data and abstract were imported from PubMed on 08 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.