1809-P: Efficacy of Pioglitazone as Adjuvant Therapy in Type 1 Diabetes Mellitus Patients: A Systematic Review and Meta-Analysis

Introduction and Objective: Type 1 diabetes mellitus requires lifelong insulin therapy; however, many patients fail to achieve optimal glycemic control. The role of adjunctive therapies to improve metabolic outcomes has therefore been explored. Pioglitazone, an insulin-sensitizing agent, has been evaluated as an adjunct in Type 1 diabetes, but available evidence regarding its efficacy and safety remains inconsistent. Other thiazolidinediones, such as rosiglitazone, were not included in this review because their clinical use has been withdrawn or severely restricted in many regions due to safety concerns. Hence, a systematic evaluation of the existing evidence was warranted. Methods: A systematic search of multiple databases identified 4,367 studies, of which three trials met the inclusion criteria. The primary outcome assessed was the mean change in HbA1c levels. Additional outcomes included mean changes in postprandial glucose, insulin dose requirements, body weight, BMI, and lipid profile. Effect estimates were calculated using a random-effects model, and Risk Ratios with 95% Confidence Intervals were reported. Risk of Bias and Certainty of Evidence were assessed using standard validated tools. Results: Three randomized controlled trials (n = 108) were included; however, only mean change in HbA1c is reported in this abstract. The pooled mean difference in HbA1c change between pioglitazone and placebo was 0.14 (95% CI −0.08 to 0.36), indicating no statistically significant improvement in glycemic control. There was no observed heterogeneity (I² = 0%). Overall risk of bias showed some concerns, mainly due to limited reporting of randomization and allocation concealment. Conclusion: Pioglitazone did not demonstrate a statistically significant improvement in HbA1c compared with placebo. Interpretation is limited by small sample sizes, highlighting the need for larger, well-designed studies. Disclosure S. Neelakantan Ramaswamy: None. P. Porchezhian: None. E. Veluchamy: None. P. Sengiah Ramaswamy: None. K. Tiwari: None.