The systematic review by Richter et al.48 assessed the effects of pioglitazone in the treatment of type 2 diabetes. The relevant outcomes for these guidelines are mortality (kidney disease) and morbidity (nephropathy). Overall the evidence for a positive patient-oriented outcome for the use of pioglitazone was considered not to be convincing. Three studies were identified that included endpoints relevant to the assessment of kidney disease namely, Hanefeld et al.,49 Matthews et al.50 and Schernthaner et al.51 The Hanefeld et al.49 study compared pioglitazone plus sulfonyl urea with metformin plus sulphonyl urea over 12 months in 649 people with type 2 diabetes with

a history of poorly controlled AP24534 diabetes. The pioglitazone treatment resulted in a 15% reduction in the urinary ACR compared with a 2% increase in the metformin group with both treatments giving clinically equivalent glycaemic control. The Matthews et al.50 study compared pioglitazone plus metformin with glicazide plus metformin in 630 people with poorly managed type 2 diabetes over 12 months. The pioglitazone treatment gave a 10% reduction in the ACR compared

with a 6% increase in the glicazide PD0332991 mw group with no significant difference in HbA1c. The Schernthaner et al.51 study included 1199 people with type 2 diabetes inadequately treated by diet alone (HbA between 7.5% and 11%) and aged between 35–75 years from 167 centres located across 12 European countries. Pioglitazone treatment resulted in a 19% decrease in ACR compared with 1% in the metformin group. Blood pressure was not statistically different between groups. The results

were considered to be consistent with previous studies that troglitazone but not metformin or glibenclamide reduced urinary albumin excretion rate. The systematic review by Richter et al.52 assessed the effects of rosiglitazone in the treatment of type 2 diabetes. The study by Lebovitz et al.53 was identified as including an outcome measure relevant to kidney disease. The study examined the use of rosiglitazone as a monotherapy in 493 people with type 2 diabetes over a 7 month period. Urinary albumin excretion was decreased significantly compared with the placebo. For the subgroup of people with microalbuminuria, both doses of rosiglitazone gave a reduction Tryptophan synthase in ACR from baseline of around 40%. Only a small percentage of patients were receiving antihypertensive therapy which the authors suggested indicates the effect to be a result of improved glycaemic control or a different effect of rosiglitazone. The measurement of urinary ACR was a secondary prospective outcome of the study of 203 people with type 2 diabetes by Bakris et al.54 comparing rosiglitazone with glyburide in a randomized controlled trial. RSG significantly reduced ACR from baseline and strongly correlated with changes in blood pressure and little relation to changes in FPG or HbA1c.