Evidence mapPaperPMID 42548745Full record

SynthesisFrontiers in clinical diabetes and healthcare2026

Dapagliflozin & pioglitazone combination therapy in T2DM with or without MASLD - a systematic review and meta-analysis: PRO-2 study.

Shashank Joshi, Shambo Samrat Samajdar, Arvind Gupta, Mithun Bhartia, Sailesh Lodha, Supratik Bhattacharyya, Krishna Seshadri, Lakshmi Nagendra, A G Unnikrishnan, Dakshata Padhye and 8 more

Abstract readSystematic Review
In one paragraph

Synthesis in Frontiers in clinical diabetes and healthcare, 2026. 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

18 authors.

Shashank JoshiDepartment of Endocrinology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.
Shambo Samrat SamajdarDepartment of Pharmacology, JMN Medical College and Hospital, Ranaghat, West Bengal, India.
Arvind GuptaRHL-Rajasthan Hospital, Jaipur, Rajasthan, India.
Mithun BhartiaApollo Hospital, Guwahati, Assam, India.
Sailesh LodhaDepartment of Endocrinology, Eternal Hospital, Jaipur, Rajasthan, India.
Supratik BhattacharyyaSKN Diabetes and Endocrine Centre, Kolkata, West Bengal, India.
Krishna SeshadriChennai Diabetes and Endocrine Clinic, Apollo Hospitals, Chennai, Tamil Nadu, India.
Lakshmi NagendraDepartment of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India.
A G UnnikrishnanChellaram Diabetes Institute, Pune, Maharashtra, India.
Dakshata PadhyeConquer Diabetes Clinic, Mumbai, Maharashtra, India.
Lakshmi Nalini KopalleFernandez Foundation Unit 1, Hyderabad, Telangana, India.
Ashok Kumar DasMahatma Gandhi Medical College and Research Centre, Pondicherry, India.
Om LakhaniZydus Hospital, Ahmedabad, India.
Jothydev KesavadevJothydev's Diabetes Research Centre, Trivandrum, Kerala, India.
Ameya JoshiBhaktivedanta Hospital & Research Institute, Mumbai, Maharashtra, India.
Sambit DasDepartment of Endocrinology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Smriti GadiaScientific Services, USV Pvt Ltd, Mumbai, Maharashtra, India.
Thamburaj AnthuvanSales & Marketing and PhD Scholar, USV Private Limited and Pimpri Chinchwad Education Trust (PCET)'s S.B. Patil Institute of Management (Savitribai Phule Pune University), Mumbai, Maharashtra, India.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Aims: To evaluate the efficacy and safety of dapagliflozin plus pioglitazone versus comparators on metabolic control and hepatic steatosis in adults with type 2 diabetes mellitus (T2DM), with or without metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: We conducted a systematic review and meta-analysis of randomized and observational studies in PubMed, Embase, Cochrane Central, Scopus, Web of Science with a search updated through January 2026, following peer review. Eligible studies enrolled adults with T2DM with or without MASLD, receiving dapagliflozin plus pioglitazone in comparison with standard care or monotherapy, or as pooled-arm exploratory estimates. The primary outcome was glycemic control (HbA1c and fasting and postprandial glucose levels). Secondary outcomes included body weight, insulin resistance indices, related liver outcomes (liver fat content, NAFLD activity score [NAS], and steatohepatitis resolution), liver enzymes, non-invasive fibrosis indices, lipid parameters, and safety outcomes. Results: Thirteen studies (n = 1411) met the inclusion criteria. Dapagliflozin-pioglitazone significantly improved glycemic control, with a reduction in HbA1c (mean difference -0.49%; 95% CI -0.64 to -0.34), and Fasting Blood Glucose (-11.96 mg/dL; 95% CI -16.30 to -7.62) and Post-Prandial Glucose (-21.54 mg/dL; 95% CI -30.84 to -12.24). Hepatic outcomes also improved, with reductions in liver fat content (standardized mean difference -0.42; 95% CI -0.61 to -0.22) and NAS (standardized mean difference -0.39; 95% CI -0.56 to -0.22), and higher rates of steatohepatitis resolution (risk ratio 1.48; 95% CI 1.13-1.92). Certainty of evidence was moderate for glycemic and steatosis outcomes and low for histological endpoints. Conclusions: Dapagliflozin-pioglitazone combination therapy was associated with improvements in glycemic control and non-invasive markers of hepatic steatosis in adults with T2DM, with or without MASLD, while maintaining a favorable safety profile. Certainty of evidence was moderate for metabolic and steatosis outcomes and low for histological endpoints. Given the predominance of surrogate hepatic endpoints and limited biopsy-confirmed data, these findings should be interpreted with appropriate caution. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1117019, identifier CRD420251117019.

Indexed as

combination therapydapagliflozinMASLDNAFLDpioglitazoneSRMAT2DM

Identifiers

PMID42548745
PMCPMC13429781

What Socratic holds

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LicenceCC BY
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Registered trials

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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.