Pioglitazone reduced a secondary composite of all-cause mortality in the PROactive study in type 2 DM patients at high risk of macrovascular disease. However, the primary outcome in PROactive did not achieve statisticl significance. Thus the inertpretation of these results remians contentious. It has been proven that the use of piiglitazone is associatded with fluid retention secondary to renal effects, and thzis associated with peripheral edema and worsening of established heart failure. Furthermore, the use of pioglitazone is dependent on renal function and this aspect must also be considered. It is doubtful that pioglitazone has a role in preventing endotelials dysunction in type 2 DM.
In some studies it has been shown that pioglitazone prevents endothelial dysfunction, most of those studies are in vitro. It is expected that such an action is carried in vivo also.
At present there is no hardcore data to support that Pioglitazone helps in combating endothelial dysfunction but they are good drug to start with in young diabetics in early state