Thiazolidinediones improves glucose, lipid levels in diabetes with renal impairment
Thiazolidinediones (TZD) improves serum lipid and glucose control in diabetic patients with renal impairment, a new meta-analysis reports. However, it may also increase the risk of oedema and weight gain.
Randomized controlled trials (RCTs) and cohort studies that compared the efficacy of TZD against placebo in hyperglycaemic patients with renal impairment were searched from the Cochrane Central Register of Controlled Trials, Embase and PuMed.
The Cochrane Collaboration’s tool for determining the risk of bias for RCTs was used while the Newcastle-Ottawa Scale was used to evaluate methodological quality of the studies.
After applying the selection criteria, 22 studies (n=21,803) were included in the meta-analysis. Of these, 19 were RCTs and three were cohort studies. Two of the cohort studies were retrospective while the other one was prospective.
Of the 19 RCTs, 5.3 (n=1) percent used both pioglitazone and rosiglitazone interventions, while 73.7 (n=14) and 21.1 (n=4) percent used pioglitazone alone and rosiglitazone alone, respectively. All RCTs had moderate to high risk of bias; one cohort study was at low risk of bias, one at moderate risk and one at high risk.
There were significant reductions in the serum levels of HbA1c (mean difference [MD], -0.64; 95 percent CI, -0.93 to -0.35) and fasting plasma glucose (MD, -26.27; -44.90 to -7.64), and a significant increase in high-density lipoprotein (MD, 3.70; 1.10 to 6.29) in the TZD group compared with controls.
While there were no significant differences in triacylglycerols (TCG), total cholesterol (TC) and low-density lipoprotein (LDL), subgroup analyses showed that pioglitazone significantly decreased TCG (MD, -26.38; -40.56 to -12.19) and TC (MD, -7.00; -13.77 to -0.23) while rosiglitazone significantly elevated TC levels (MD, 13.51; 0.48 to 26.54).
Finally, TZD significantly increased the risk of weight gain (MD, 3.23; 2.29 to 4.16) and oedema (risk ratio [RR], 2.96; 1.22 to 7.20). There were no significant effects on the risk of all-cause mortality, cardiovascular events and hypoglycaemia.