Evidence mapPaperPMID 41122558Full record

ReviewCureus2025

Pioglitazone as Add-On to Metformin and Dapagliflozin Yields Significant Enhancements in Glycemic Control in Poorly Controlled Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials.

Sara Sabbagh, Ahmed Hegazy, Ahmed Adel, Abdullah Ali, Mohamed Alquddosy, Sara Khalid, Abdallah M Ibrahim, Ahmed Mohamed, Abdelrahman Mostafa, Ahmed Hassan and 4 more

Abstract readReview
In one paragraph

Review in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Sara SabbaghFaculty of Medicine, Damascus University, Damascus, SYR.
Ahmed HegazyAcute Medicine, Medway NHS Foundation Trust, Gillingham, GBR.
Ahmed AdelFaculty of Medicine, Zagazig University, Zagazig, EGY.
Abdullah AliFaqous Faculty of Medicine, Zagazig University, Faqous, EGY.
Mohamed AlquddosyFaculty of Medicine, Mansoura University, Mansoura, EGY.
Sara KhalidFaculty of Medicine, Helwan University, Cairo, EGY.
Abdallah M IbrahimFaculty of Medicine, Alexandria University, Alexandria, EGY.
Ahmed MohamedFaculty of Medicine, Al-Azhar University, Cairo, EGY.
Abdelrahman MostafaFaculty of Medicine, Alexandria University, Alexandria, EGY.
Ahmed HassanFaculty of Medicine, Al-Azhar University, Cairo, EGY.
Ola MohamedFaculty of Medicine, Al-Azhar University, Cairo, EGY.
Rawan MesbahFaculty of Medicine, October 6th University, 6th of October City, EGY.
Osama OsmanFaculty of Medicine, Mari State University, Yoshkar-ola, RUS.
Mohamed Hamouda ElkasabyFaculty of Medicine, Al-Azhar University, Cairo, EGY.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

This systematic review and meta-analysis aimed to evaluate the efficacy and safety of pioglitazone as an add-on therapy to dual treatment with metformin and dapagliflozin in adults with type 2 diabetes mellitus (T2DM) inadequately controlled on this regimen. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing pioglitazone (15 or 30 mg) versus placebo as an add-on to metformin (1,000 mg/day) and dapagliflozin (10 mg/day). Four databases (PubMed, Scopus, Cochrane CENTRAL, and Web of Science) were searched through December 2024. Primary outcomes included changes in hemoglobin A1c (HbA1c), the proportion of patients achieving a therapeutic glycemic response, and fasting plasma glucose (FPG). Secondary outcomes were insulin resistance, β-cell function, lipid parameters, body weight, blood pressure, and adverse events. Mean difference (MD) and standard deviation (SD) were used to describe the continuous variables. For categorical variables, we used the risk ratio (RR) and 95% confidence interval (CI). We included three RCTs, comprising a total of 856 patients: 363 received pioglitazone 15 mg, 124 received the 30 mg dose, and 369 received a placebo. Pioglitazone 15 mg significantly reduced HbA1c (MD = -0.42 percentage point, 95% CI = -0.51 to -0.33; p < 0.00001) and FPG (MD = -12.41 mg/dL). The 30 mg dose yielded greater reductions in HbA1c (MD = -0.84 percentage point) and FPG (MD = -21.49 mg/dL). It also improved homeostatic model assessment of insulin resistance, high-density lipoprotein cholesterol, and triglycerides, but increased body weight. No significant differences in serious adverse events or hypoglycemia were observed. Most outcomes had moderate to high certainty. Adding pioglitazone to metformin and dapagliflozin significantly enhances glycemic control and improves metabolic parameters with an acceptable safety profile, supporting its role as an effective triple oral therapy in T2DM.

Indexed as

dapagliflozinmetforminpioglitazonetriple oral therapytype 2 diabetes mellitus

Identifiers

PMID41122558
PMCPMC12536928

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.