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What is the role of pioglitazone for patients with type 2 diabetes in value-based care settings?

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Abstract

Type 2 diabetes is a significant burden on the healthcare system with unique challenges in the value-based payment system. Although there are a variety of antidiabetic medications with clinical benefit, access to newer treatments are often limited in value-based settings due to cost, availability, and insurance coverage. Thiazolidinediones (TZDs) are glucose-lowering medications indicated for the management of type 2 diabetes that are often overlooked in therapy. These insulin sensitizing medications lower blood glucose and are less costly than other antidiabetic agents. Although concerns regarding safety issues and side effects of TZDs has limited their use in current practice, evidence-based guidelines still recommend pioglitazone in select patients and its use remains important. Pioglitazone should be prioritized in patients with a history of stroke or who have high risk of stroke and atherosclerotic cardiovascular disease (ASCVD), or patients on antidiabetic therapy who require additional A1c lowering. Pioglitazone should be avoided in patients with heart failure, edema, obesity, low bone mineral density, and a history of bladder cancer. This article discusses advantages and disadvantages of pioglitazone therapy, selecting patients who may be candidates for pioglitazone therapy, and considerations for prescribing in value-based settings.

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Authors and Affiliations

  1. PGY2 Ambulatory Care Pharmacy Resident, Nova Southeastern University College of Pharmacy, 3200 S University Drive, Fort Lauderdale, FL, 33328, USA

    Andrea Bush

  2. Nova Southeastern University College of Pharmacy, 3200 S University Drive, Fort Lauderdale, FL, 33328, USA

    Tina Benny & Matthew Seamon

  3. Nova Southeastern University College of Pharmacy, 11501 North Military Trail, Palm Beach Gardens, FL, 33410, USA

    Genevieve Hale

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Correspondence to Andrea Bush.

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All authors contributed to the study conception, design, and research. The first draft of the manuscript was written by Andrea Bush and Tina Joseph and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Bush, A., Benny, T., Hale, G. et al. What is the role of pioglitazone for patients with type 2 diabetes in value-based care settings?. Drugs Ther Perspect 40, 131–136 (2024). https://doi.org/10.1007/s40267-024-01052-1

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