Clinical Evaluation of Pioglitazone's Impact on Insulin Resistance and Blood Pressure in Type 2 Diabetic Patients Undergoing Hemodialysis

Abstract

Background: Globally, type 2 diabetes mellitus (T2DM) is becoming more common, especially in individuals receiving hemodialysis for end-stage renal disease (ESRD). This population faces heightened risks of cardiovascular complications and poor glycemic control. Pioglitazone, an insulin sensitizer, has shown potential in improving metabolic and cardiovascular parameters but its application in hemodialysis patients remains underexplored.

Aim: To assess the impact of pioglitazone on blood pressure, glycemic management, and insulin resistance in patients with type 2 diabetes receiving hemodialysis.

Methods: This prospective observational study included 100 type 2 diabetic patients on maintenance hemodialysis. Participants were administered pioglitazone (15–30 mg daily) for six months. Baseline and follow-up parameters including HbA1c, fasting insulin, HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), and blood pressure were measured. Statistical analyses were performed using SPSS version 23.0, with paired t-tests and Chi-square tests to assess pre- and post-treatment differences.

Results: Significant improvements were observed post-treatment: HbA1c decreased from 8.5 ± 1.2% to 7.3 ± 1.0% (p < 0.001), fasting insulin levels reduced from 24.8 ± 6.5 µIU/mL to 17.5 ± 4.8 µIU/mL (p < 0.001), and HOMA-IR declined from 5.8 ± 1.4 to 3.4 ± 0.8 (p < 0.001). Systolic and diastolic blood pressure decreased by 11.7 mmHg and 6.1 mmHg, respectively (p < 0.001). 85% of participants showed improvement, 10% had no change, and 5% reported mild adverse effects.

Conclusion: Pioglitazone significantly improved insulin resistance, glycemic control, and blood pressure in type 2 diabetic patients on hemodialysis, with minimal adverse effects.

Recommendations: Further large-scale, randomized controlled trials are recommended to establish long-term safety and efficacy of pioglitazone in this patient population. Routine monitoring for potential side effects is advised when using pioglitazone in clinical practice.

Keywords: Pioglitazone, Type 2 Diabetes Mellitus, Hemodialysis, Insulin Resistance, Cardiovascular Risk