Pioglitazone may accelerate disease course of slowly progressive type 1 diabetes

Background It has been reported that intervention with insulin in slowly progressive type 1 diabetic (SPIDDM) patients delays the progression to an insulin-dependent state compared to that with sulfonylureas. However, the rate of progression to SPIDDM with the use of insulin-sensitizing agents is unknown. The aim of this study was to determine the effect of insulin-sensitizing agents on SPIDDM patients. Methods The enrolled SPIDDM patients were randomly allocated to a pioglitazone or metformin group. When the haemoglobin A1C level was more than 8% on two consecutive occasions, the case was considered to reach the end point. Results By 4 years post-intervention, all patients had reached the end point in the pioglitazone group, whereas only 20% of patients had reached the end point in the metformin group (p < 0.05). Conclusions Pioglitazone may accelerate the disease course of SPIDDM. Copyright (C) 2011 John Wiley & Sons, Ltd.