Diabetes Self-Management Blog

Once-daily treatment with the diabetes drug pioglitazone (brand name Actos) was able to halt progression of prediabetes to Type 2 diabetes in a majority of people, report researchers from the University of Texas Health Science Center and seven collaborating institutions. Prediabetes currently affects an estimated 57 million people in the United States.

Pioglitazone is an oral medicine typically taken once a day, with or between meals, by people with Type 2 diabetes. The drug works by improving insulin sensitivity and decreasing the production of glucose in the liver. To see if pioglitazone could affect the progression from prediabetes (a condition in which blood glucose levels are elevated, but not yet within the diabetic range) to Type 2 diabetes, researchers recruited 602 people who were at high risk for diabetes based on their family history, obesity, and fasting plasma glucose levels between 95 mg/dl and 125 mg/dl. (Partial funding for the research was provided by pioglitazone’s manufacturer, Takeda Pharmaceuticals.) The participants were randomly assigned to take either pioglitazone or a placebo (inactive pill) once a day in the morning and were followed for an average of 2.4 years.

At the end of the follow-up period, the researchers found that, compared to placebo, pioglitazone reduced the progression from prediabetes to Type 2 diabetes by 72%. Additionally, use of pioglitazone was associated with a reduction in the rate of thickening of the carotid artery, which brings blood to the brain, as well as a lowering of blood pressure and an increase in the amount of HDL (“good”) cholesterol compared to placebo.

According to senior author Ralph DeFronzo, MD, “It’s a blockbuster study. The 72 percent reduction is the largest decrease in the conversion rate of prediabetes to diabetes that has ever been demonstrated by any intervention, be it diet, exercise, or medication.” Robert R. Henry, MD, President, Medicine & Science, of the American Diabetes Association, noted that “It is the most efficacious method we have studied to date to delay or prevent the onset of Type 2 diabetes.”

The medicine did have a number of side effects at the dose used in the study, including significant weight gain and fluid retention. (Another drug in this class, rosiglitazone [Avandia], was recently restricted by the US Food and Drug Administration due to safety concerns.) Additionally, it is unclear both what happens when a person stops taking the medicine and whether treating people with prediabetes is more effective than treating people after they have developed diabetes in terms of preventing complications. In an interview with Fox News, Jill Crandall, MD, a diabetes researcher at the Albert Einstein College of Medicine, said, “Lifestyle change, such as weight loss and exercise, remains the best option for those who can do it.”

To learn more about the study, read the article “Drug Prevents Type 2 Diabetes in Majority of High-Risk Individuals” or see the study’s abstract in The New England Journal of Medicine. And to learn more about pioglitazone, click here.


  1. This is a most curious article/study. I was on Actos for a number of years and till I got serious exercise/walking and correcting carbs control and diet; it was the only drug that would getmy glucose number down ( to 180)

    My kidney Doctor wanted me off it as prior to corrections; body was full of extra fluid, couldn’t lose a pound etc.

    Today, with liver under control, hearty exercise and carbs control enforced at 1200 cal diet, BG now under control, eye hemorages healed, kidney stabalized and slowly improving and weight dropping - ACTOS gone.

    ACTOS is a curious drug and will stuff more glucose in cells when nothing else works.

    So I find study most curious. My type 2 worsened while on this drug and things only improved with hearty exercise and shutting down liver dawn and dump escapades that would ram BG skyward.

    I am not against ACTOS - only find study curious.

    Posted by jim snell |
  2. I didn’t get a chance to see if it worked for me.
    I got laid off and lost my medical coverage. my doctor prescribed it to me but I can’t afford to buy it. It really stinks when there is a drug that COULD work for you but it is out of your reach because of cost.

    Posted by Diana L Simone |
  3. I had good luck on Actos for a period of 5 years,
    then side affects of swelling, weight gain, and
    fatigue. Most medicare health plans will not cover this drug, $290.00 for 15 30mg. tabs is
    way out of line. I have increased exercise and
    diet and am doing great without this product!

    Posted by j lally |
  4. Diana, when I was on Actos, Takeda Pharmaceuticals had a rebate coupon I sent in monthly for a rebate of up to $50 off the Rx. Look up their customer service number on the internet to see if they have any programs to help with the cost of the drug. I found them to be very helpful! Most of the diabetes manufacturers are…my favorite is Roche/Accu-Chek Plus meter folks. Good luck! S2

    Posted by Sue Stevenson |
  5. I was on actos for years until my ophthalmologist told me that I had macular edema(swelling). He said that there was evidence that actos and avandia helped caused this. I took this to my diabetic doctor and he said that we might as well be sure of this, even though he hadn’t read any studies on this. He took me off the actos and doubled my metformin. Within about 2 months the swelling had gone down.

    Posted by Dennis Miller |
  6. I am very disappointed with Diabetes Self Management Magazine. Why would an editor allow for this article Titled “Breaking News” to be printed, about a drug that has been marketed by its maker since July 1999. This study is bogus due to the fact the drug manufacture Takeda partially funded this study.

    I was on Actos, however my Doctor pulled me off of this drug when the FDA black labeled this product recently. Not only is edema, a problem, but there is a very high risk of Congestive Heart Failure, Fractures, Heart Attacks, and Stroke.

    Folks this is a dangerous drug that has been around for several years, and since the Black Label has been given to this drug, the manufacture has lost millions in sales, so they have released this bogus study in hopes of increasing sales they have lost.

    I again am very, very disappointed with Diabetes Self Management Magazine for printing this article. Editors should use a little more care instead of getting people excited about a new drug that is not new.

    Posted by E Storer |
  7. Whoa: the feedback here maps directly to my experience and not just one only.

    Thats not good! Most interesting is the comments about getting exercise, diet and metformin and getting off this drug. Cost was always an issue.

    Why does the study not relate this info?

    Posted by jim snell |
  8. Hi E Storer,

    Thanks for your comment and for sharing your experiences with Actos.

    The article does not claim that Actos is a new drug; as you note, it was approved by the US Food and Drug Administration in 1999. What is new, however, is the information gathered in this recent study indicating that Actos may potentially have a role in preventing Type 2 diabetes in people who are at risk. My apologies for any confusion.

    Also, just to clarify, it was Avandia (another diabetes drug in the same class as Actos) that recently had a black box warning added to its label, not Actos.

    Thank you for your interest in Diabetes Self-Management.

    Diane Fennell
    Web Editor

    Posted by Diane Fennell |
  9. Yes, the FDA has not gotten to blacklisting Actos yet! The data and experience is not good nor acceptable.

    I was surprised to learn that Takeda had supposedly funded this study. Is that correct?
    My Doctor’s said after Avandia, that the good folks would get to focusing on Actos as well.

    Same class and family of drugs.

    Posted by jim snell |
  10. Hello Mr. Snell,

    Thank you for your comment. Yes, as indicated in the second paragraph of this article, “Partial funding for the research was provided by pioglitazone‚Äôs manufacturer, Takeda Pharmaceuticals.”

    Thanks for your interest in Diabetes Self-Management.

    Diane Fennell
    Web Editor

    Posted by Diane Fennell |
  11. Given that Actos is now linked to bladder cancer, it seems like it should only be used as a last resort.


    Also, wasn’t the blackbox warning about heart attacks issued on the entire class of TZD, including both Actos and Avandia?

    Posted by carol |

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