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Cited by 752Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and ManagementPeroxisome Proliferator-Activated Receptors

Pioglitazone for Diabetes Prevention in Impaired Glucose Tolerance

Open access
DeFronzo, Ralph A., Tripathy, Devjit, Schwenke, Dawn C., Banerji, MaryAnn, Bray, George A., Buchanan, Thomas A., Clement, Stephen C., Henry, Robert R. +9 more·2011·New England Journal of Medicine
DOI 10.1056/nejmoa1010949
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Abstract

BACKGROUND: Impaired glucose tolerance is associated with increased rates of cardiovascular disease and conversion to type 2 diabetes mellitus. Interventions that may prevent or delay such occurrences are of great clinical importance. METHODS: We conducted a randomized, double-blind, placebo-controlled study to examine whether pioglitazone can reduce the risk of type 2 diabetes mellitus in adults with impaired glucose tolerance. A total of 602 patients were randomly assigned to receive pioglitazone or placebo. The median follow-up period was 2.4 years. Fasting glucose was measured quarterly, and oral glucose tolerance tests were performed annually. Conversion to diabetes was confirmed on the basis of the results of repeat testing. RESULTS: Annual incidence rates for type 2 diabetes mellitus were 2.1% in the pioglitazone group and 7.6% in the placebo group, and the hazard ratio for conversion to diabetes in the pioglitazone group was 0.28 (95% confidence interval, 0.16 to 0.49; P<0.001). Conversion to normal glucose tolerance occurred in 48% of the patients in the pioglitazone group and 28% of those in the placebo group (P<0.001). Treatment with pioglitazone as compared with placebo was associated with significantly reduced levels of fasting glucose (a decrease of 11.7 mg per deciliter vs. 8.1 mg per deciliter [0.7 mmol per liter vs. 0.5 mmol per liter], P<0.001), 2-hour glucose (a decrease of 30.5 mg per deciliter vs. 15.6 mg per deciliter [1.6 mmol per liter vs. 0.9 mmol per liter], P<0.001), and HbA(1c) (a decrease of 0.04 percentage points vs. an increase of 0.20 percentage points, P<0.001). Pioglitazone therapy was also associated with a decrease in diastolic blood pressure (by 2.0 mm Hg vs. 0.0 mm Hg, P=0.03), a reduced rate of carotid intima-media thickening (31.5%, P=0.047), and a greater increase in the level of high-density lipoprotein cholesterol (by 7.35 mg per deciliter vs. 4.5 mg per deciliter [0.4 mmol per liter vs. 0.3 mmol per liter], P=0.008). Weight gain was greater with pioglitazone than with placebo (3.9 kg vs. 0.77 kg, P<0.001), and edema was more frequent (12.9% vs. 6.4%, P=0.007). CONCLUSIONS: As compared with placebo, pioglitazone reduced the risk of conversion of impaired glucose tolerance to type 2 diabetes mellitus by 72% but was associated with significant weight gain and edema. (Funded by Takeda Pharmaceuticals and others; ClinicalTrials.gov number, NCT00220961.).

Integrity signals

Registry

Crossref · 10.1056/nejmoa1010949

Cites

44 of 44 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 26 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Hyperglycemia plays a central role in the microvascular and macrovascular complications of diabetes.

    “Because hyperglycemia plays a central role in the microvascular and macrovascular complications of diabetes, 3,5,6 it is possible that interventions that prevent or delay hyperglycemia may effectively prevent or delay these long-term complications.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [3] source
    • cites [5] source
    • cites [6] source

      In the opening results passage (page unavailable), the paper says hyperglycemia plays a central role in microvascular complications of type 1 diabetes. A later results passage says differences in glycosylated hemoglobin accounted for much of the cardiovascular benefit of intensive therapy, supporting a role in macrovascular disease. The claim extends these type 1 findings to diabetes generally and states the macrovascular role more definitively than the paper does. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • Findingown data

    As compared with placebo, pioglitazone reduced the risk of conversion from impaired glucose tolerance to type 2 diabetes mellitus by 72% (hazard ratio, 0.28; 95% CI, 0.16 to 0.49; P<0.001).

    “As compared with placebo, pioglitazone reduced the risk of conversion of impaired glucose tolerance to type 2 diabetes mellitus by 72% but was associated with significant weight gain and edema.”
    • Also stated in: § Follow-up · plain
      “The hazard ratio for development of diabetes in the pioglitazone group was 0.28 (95% confidence interval, 0.16 to 0.49; P<0.001).”
    Quote in the paperSubstantial claim
  • Findingown data

    The difference between pioglitazone and placebo groups in triglyceride levels was not significant.

    “Triglyceride levels declined significantly with pioglitazone (129±7.5 to 110±4.0 mg per deciliter [7.2±0.42 to 6.1±0.22 mmol per liter], P = 0.007) but not with placebo (124±4.6 to 113±4.0 mg per deciliter [6.9±0.25 to 6.30±0.22mmol per liter], P = 0.90); the difference between groups was not significant.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Triglyceride levels declined significantly with pioglitazone (129±7.5 to 110±4.0 mg/dL, P=0.007).

    “Triglyceride levels declined significantly with pioglitazone (129±7.5 to 110±4.0 mg per deciliter [7.2±0.42 to 6.1±0.22 mmol per liter], P = 0.007) but not with placebo (124±4.6 to 113±4.0 mg per deciliter [6.9±0.25 to 6.30±0.22mmol per liter], P = 0.90); the difference between groups was not significant.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Pioglitazone reduced alanine aminotransferase levels compared with placebo (P<0.001).

    “As compared with placebo, pioglitazone reduced levels of both alanine aminotranferase and aspartate aminotransferase (P<0.001).”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 16
  • May combine two claims. 18
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Food and Drug Administration has restricted the use of rosiglitazone therapy to patients in whom glycemic control cannot be achieved with other medications and who cannot take pioglitazone.

    “In one study, 9 the use of rosiglitazone decreased the risk of diabetes in adults with impaired glucose tolerance by 62%; given concerns about cardiovascular safety, 14 however, the Food and Drug Administration has restricted the use of rosig litazone therapy to patients in whom glycemic control cannot be achieved with other medications and who cannot take pioglitazone.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] source

      The Results report increased odds of myocardial infarction with rosiglitazone, supporting the cardiovascular-safety concern immediately preceding citation 14. But the supplied claim concerns an FDA restriction: the Discussion describes FDA approval criteria, not a restriction limiting rosiglitazone to patients who cannot use other medications or pioglitazone. Searches for those eligibility conditions found no supporting passage in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The natural history of type 2 diabetes mellitus is well defined, progressing from normal glucose tolerance with insulin resistance to impaired glucose tolerance and eventually type 2 diabetes with beta-cell failure.

    “The natural history of type 2 diabetes mellitus has been well defined, 4 starting with a genetic predisposition and progression from normal glucose tolerance with insulin resistance to impaired glucose tolerance and eventually type 2 diabetes mellitus with the superimposition of beta-cell failure.”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    The rate of conversion of impaired glucose tolerance to type 2 diabetes mellitus is reduced with lifestyle modification, metformin, thiazolidinediones, acarbose, and bariatric surgery.

    “Studies have shown that the rate of conversion of impaired glucose tolerance to type 2 diabetes mellitus is reduced with lifestyle modification 7 ; the use of metformin, 7 thiazolidinediones, [8][9][10][11] or acarbose 12 ; and bariatric surgery.13”
    Quote in the paperSubstantial claim1 of 6 sources checked
    • cites [7] source
    • cites [8] source
    • cites [9] source
    • cites [10] source

      This citation is attached to the thiazolidinediones clause, not the other interventions. The Discussion reports that troglitazone reduced diabetes incidence by 75% during treatment, but explicitly says whether other thiazolidinediones are effective remains to be determined. It therefore supports troglitazone, not the class-wide claim without qualification. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [11] source
    • cites [12] source

  • May combine two claims.

    Findingown data

    The number needed to treat to prevent one case of diabetes was 8 for 2.2 years and 18 for 1 year.

    “The number of people who would need to be treated to prevent one case of diabetes was 8 for 2.2 years of the trial and 18 for 1 year.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Diabetes developed in 50 of 299 patients in the placebo group (16.7%) and 15 of 303 patients in the pioglitazone group (5.0%).

    “During a median follow-up period of 2.4 years (mean, 2.2), diabetes developed in 50 of the 299 patients in the placebo group (16.7%) and in 15 of the 303 patients in the pioglitazone group (5.0%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Protection from diabetes with pioglitazone was of similar magnitude across subgroups defined by sex, age, weight, race or ethnic group, fasting glucose level, and IGT/IFG status, with no significant heterogeneity.

    “Protection from diabetes with pioglitazone was of similar magnitude (with no significant heterogeneity) in subgroups defined by sex, age, weight, race or ethnic group, and fasting glucose level, as well as in patients with both impaired glucose tolerance and impaired fasting glucose and those with isolated impaired glucose tolerance (Fig. 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Neither pioglitazone nor placebo altered LDL cholesterol levels.

    “Neither pioglitazone nor placebo altered levels of low-density lipoprotein cholesterol.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Nine fractures occurred in 8 patients receiving pioglitazone (3%) and eight fractures occurred in 7 patients receiving placebo (2.6%), and all fractures were associated with trauma.

    “Nine fractures occurred in 8 of the patients receiving pioglitazone (3%) and eight fractures occurred in 7 of the patients receiving placebo (2.6%) (Table 4 in the Supplementary Appendix).All fractures were associated with trauma.”
    • Also stated in: § Discussion · plain
      “Although an increased incidence of fractures has been reported with the use of thiazolidinediones, in this study, the incidence was similar in both groups, and all fractures were related to trauma.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Cardiovascular system events numbered 23 in the placebo group (7.7%) and 26 in the pioglitazone group (8.6%), with 1 case of congestive heart failure in each group (0.3%), and the frequency did not differ significantly (P=0.80).

    “Events related to the cardiovascular system numbered 23 in the placebo group (7.7%) and 26 in the pioglitazone group (8.6%) (Table 3 in the Supplementary Appendix), with 1 case of congestive heart failure in each group (0.3%).”
    • Also stated in: § Discussion · plain
      “Physician-reported congestive heart failure developed in only one patient in each group.”
    • Also stated in: § Discussion · plain
      “For the comparison of placebo and pioglitazone regarding frequency of edema, cardiovascular events, and total events, P = 0.007, P = 0.80, and P = 0.03, respectively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The ratio of urinary microalbumin to creatinine was low at baseline and fell slightly and similarly in the pioglitazone and placebo groups during the study (1.85±0.2 to 1.53±0.2 mg per gram vs. 1.47±0.3 to 1.25±0.3 mg per gram, P=0.20).

    “The ratio of urinary microalbumin to creatinine was low at baseline; during the study it fell slightly and similarly in the two groups (1.85±0.2 to 1.53±0.2mg per gram in the pioglitazone group vs. 1.47±0.3 to 1.25±0.3mg per gram in the placebo group, P = 0.20).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Insulin resistance was reduced according to the Matsuda index measured during the oral glucose-tolerance test but not according to measurement of insulin sensitivity during the frequent-sampling intravenous glucose-tolerance test.

    “Although pioglitazone is a well-documented insulin sensitizer, insulin resistance was reduced according to the Matsuda index of insulin sensitivity measured during the oral glucose-tolerance test but not according to measurement of insulin sensitivity during the frequent-sampling intravenous glucose-tolerance test.”
    • Also stated in: § Discussion · plain
      “Insulin sensitivity as determined with the use of an intravenous glucose-tolerance test with frequent sampling in a subgroup of 191 patients was not altered in either group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Pioglitazone was associated with lower diastolic blood pressure, higher HDL cholesterol levels, and reduced rates of carotid intima-media thickening, as compared with placebo.

    “Pioglitazone was associated with lower diastolic blood pressure, higher levels of HDL cholesterol, and reduced rates of carotid intima-media thickening, as compared with placebo.”
    • Also stated in: § Discussion · plain
      “Use of pioglitazone improved diastolic blood pressure, HDL cholesterol levels, and serum levels of alanine aminotranferase and aspartate aminotransferase, and it slowed progression of carotid intima-media thickening.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    One unexplained sudden death occurred in the placebo group, and three deaths occurred in the pioglitazone group (one unexplained sudden death, one death from biliary carcinoma, and one death from a carcinoid tumor).

    “One unexplained sudden death oc-curred in the placebo group, and three deaths occurred in the pioglitazone group (one unexplained sudden death, one death from biliary carcinoma, and one death from a carcinoid tumor).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Edema and weight gain were greater with pioglitazone than with placebo.

    “Edema and weight gain were greater with pioglitazone than with placebo, as reported previously, 8,40 and edema largely accounted for the increase in adverse events associated with pioglitazone.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [8] source
    • cites [40] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Enrollment of approximately 600 patients was required to achieve 90% power if pioglitazone decreased the rate of conversion from impaired glucose tolerance to type 2 diabetes by 50%.

    “We calculated that enrollment of approximately 600 patients was required to achieve 90% power, if treatment with pioglitazone decreased the rate of conversion from impaired glucose tolerance to type 2 diabetes mellitus by 50%.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Rosiglitazone decreased the risk of diabetes in adults with impaired glucose tolerance by 62%.

    “In one study, 9 the use of rosiglitazone decreased the risk of diabetes in adults with impaired glucose tolerance by 62%; given concerns about cardiovascular safety, 14 however, the Food and Drug Administration has restricted the use of rosig litazone therapy to patients in whom glycemic control cannot be achieved with other medications and who cannot take pioglitazone.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] source

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Further glycemic separation between groups over time would presumably have a beneficial effect on microvascular disease.

    “However, further glycemic separation between groups over time would presumably have a beneficial effect on microvascular disease.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    There was no statistically significant evidence of bias due to missing data, and the primary and secondary analyses were performed without data imputation.

    “Since neither approach produced statistically significant evidence of bias due to missing data, the primary and secondary analyses were performed without data imputation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Takeda Pharmaceuticals provided financial support for the study but had no access to the data.

    “Takeda Pharmaceuticals provided financial support for the study but had no access to the data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    All results were recorded and audited at the Data Coordinating Center before being sent to the Data Analysis Center.

    “All results were transmitted to the Data Coordinating Center in Phoenix, Arizona, where they were recorded and audited and then sent to the Data Analysis Center in San Antonio.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was conducted in accordance with the protocol.

    “The study was conducted in accordance with the protocol.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Troglitazone was associated with a 55% decrease in the rate of conversion to diabetes among women with prior gestational diabetes.

    “Troglitazone was reported to be associated with a 55% decrease in the rate of conversion to diabetes among women with prior gestational diabetes, 11 but this agent is no longer available.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The small difference in HbA1c levels between the two groups is not surprising, given the low baseline HbA1c level in patients with impaired glucose tolerance.

    “The small difference in levels of HbA 1c between the two groups is not surprising, given the low baseline level of HbA 1c in patients with impaired glucose tolerance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Adherence to the study regimen was greater than 80% in both the pioglitazone and placebo groups.

    “The rate of adherence to the study regimen, assessed by means of pill counts, was greater than 80% in both groups.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    If development of diabetic hyperglycemia can be delayed or prevented, it is plausible that the onset of microvascular complications might be slowed.

    “However, if development of diabetic hyperglycemia can be delayed or prevented, it is plausible that the onset of microvascular complications might be slowed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    It is not feasible to conduct studies of microvascular outcomes in patients with impaired glucose tolerance because of the large sample and long study duration required.

    “It is not feasible to conduct studies of microvascular outcomes in patients with impaired glucose tolerance because of the large sample and long study duration required.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Loss to follow-up was relatively high in both study groups (24% in the placebo group and 30% in the pioglitazone group, not a significant difference).

    “Loss to follow-up was relatively high in both study groups (24% in the placebo group and 30% in the pioglitazone group, not a significant dif-ference).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Microvascular and macrovascular complications are common in type 2 diabetes mellitus and are related to both the severity and duration of hyperglycemia.

    “Microvascular and macrovascular complications are common in type 2 diabetes mellitus and are related to both the severity and the duration of hyperglycemia. 3”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The study was a randomized, double-blind, placebo-controlled trial.

    “We conducted a randomized, double-blind, placebo-controlled study to examine whether pioglitazone can reduce the risk of type 2 diabetes mellitus in adults with impaired glucose tolerance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The greater the weight gain, the greater the improvements in beta-cell function and insulin sensitivity, and thus the greater the reduction in HbA1c.

    “However, the greater the weight gain, the greater the improvements in betacell function and insulin sensitivity, and thus the greater the reduction in HbA 1c .26,35,36”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [26] source
    • cites [35] source
    • cites [36] source

  • May combine two claims.

    Premisecitation

    Carotid intima-media thickening is highly correlated with cardiovascular events, and changes in this measure over time have predictive value beyond standard markers of risk.

    “Carotid intima-media thickening is highly correlated with cardiovascular events, and changes in this measure over time have predictive value beyond that of standard markers of risk.18,38”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [18] source
    • cites [38] source
31 of 31

  • The paper relies on this without support.

    Impaired glucose tolerance is associated with increased rates of cardiovascular disease.

    “Impaired glucose tolerance is associated with increased rates of cardiovascular disease and conversion to type 2 diabetes mellitus.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • There is strong evidence that oral glucose-lowering medications approved for diabetes reduce progression from prediabetes to diabetes.

    “There is strong evidence that oral glucose-lowering medications approved for DM reduce the progression of prediabetes to DM.888–896”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [890]

  • Metformin can be combined with linagliptin to decrease diabetes incidence more than metformin alone.

    “Metformin can also be combined with linagliptin to decrease DM incidence over that observed with metformin alone.890”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [890]

    The Discussion (page unavailable) says metformin reduces conversion to type 2 diabetes, while the Results compare pioglitazone with placebo. Searches for linagliptin and metformin combinations found no passage addressing whether adding linagliptin reduces diabetes incidence more than metformin alone. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • In the Swedish Obese Subjects Study, subjects were not randomized, the control group was contemporaneously matched, only received conventional treatment, and differed by a number of characteristics at baseline.

    “However, these hypotheses are based on results from the Swedish Obese Subjects Study in which subjects were not randomized and the control group was contemporaneously matched, only received conventional treatment, and differed by a number of characteristics at baseline.”

    From Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future (2014) · cites this paper as [174]

  • In the DPP Outcomes study, 19% of controls converted to normoglycaemia.

    “Other studies have reported lower conversion rates29 (19% in controls in the DPP Outcomes study).15”

    From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [29]

  • Pioglitazone showed effectiveness in the ACT NOW Study on obese people with IGT: diabetes risk decreased by over 70%, with improved diastolic blood pressure, improved HDL-cholesterol, and reduced carotid intima-media thickening, but greater weight gain (~3 kg) and more frequent edema (13% vs 6%).

    “Pioglitazone showed effectiveness in the ACT NOW Study on obese people with IGT. The risk of diabetes decreased by >70% and the drug was associated with improved diastolic blood pressure, improved HDL-cholesterol and a reduced rate of carotid intima-media thickening. However, weight gain was greater with pioglitazone (~3 kg compared to placebo) and edema was more frequently reported (13% vs. 6%).”

    From Prediabetes: a high-risk state for diabetes development (2012) · cites this paper as [29]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Placebo fracture percentage does not match its patient count

    Minor

    Seven of 299 placebo patients is about 2.34%, which rounds to 2.3% at the reported precision, not 2.6%.

    Reported 2.6 · recomputed 2.341137

  • Pioglitazone baseline BMI differs between sections

    Minor

    Table 1 gives the pioglitazone group's baseline mean BMI as 33.0, whereas the later baseline-to-follow-up values give it as 34.1.

  • Triglyceride conversion is too high

    Minor

    Using the paper's triglyceride conversion factor of 0.01129, 129 mg per deciliter is about 1.46 mmol per liter, not 7.2.

    Reported 7.2 · recomputed 1.45641

  • HDL cholesterol conversion is too high

    Minor

    The paper specifies a cholesterol conversion factor of 0.02586, which converts 40 mg per deciliter to about 1.03 mmol per liter, not 2.2.

    Reported 2.2 · recomputed 1.0344

4 of 4

Cites

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Cited by

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Related

Authors
DeFronzo, R. A., Tripathy, D., Schwenke, D. C., Banerji, M., Bray, G. A., Buchanan, T. A., Clement, S. C., Henry, R. R., Hodis, H. N., Kitabchi, A. E., Mack, W. J., Mudaliar, S., Ratner, R. E., Williams, K., Stentz, F. B., Musi, N., & Reaven, P. D.
Affiliations
  • The University of Texas at San Antonio Health Science Center (US)
  • Texas Diabetes Institute (US)
  • Phoenix VA Health Care System (US)
  • Pennington Biomedical Research Center (US)
  • University of Southern California (US)
  • Georgetown University (US)
  • University of California San Diego (US)
  • University of Tennessee Health Science Center (US)
  • MedStar Health Research Institute (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2011-03-24
Volume
364
Issue
12
Pages
1104-1115
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1010949
OpenAlex
W2131330057
Semantic Scholar
2537f2b5521882869eda52ee137db9e85431749f
Cited by
752
References
42
Citations by year
2026: 21 · 2025: 16 · 2024: 43 · 2023: 34 · 2022: 34 · 2021: 49 · 2020: 44 · 2019: 45 · 2018: 58 · 2017: 54 · 2016: 52 · 2015: 60 · 2014: 61 · 2013: 69 · 2012: 70
FWCI
44.28
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Peroxisome Proliferator-Activated Receptors
Keywords
pioglitazone, impaired glucose tolerance, type 2 diabetes prevention, thiazolidinediones, glucose tolerance, fasting blood glucose, HbA1c, carotid intima-media thickening
MeSH terms
Pioglitazone, Adolescent, Adult, Blood Glucose, Blood Pressure, Diabetes Mellitus, Type 2, Double-Blind Method, Edema, Follow-Up Studies

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