Background: A limitation with randomized controlled trials is that, while they provide unbiased evidence of the efficacy of interventions, they do so under unreal conditions and in a very limited and highly selected patient population. Our aim was to provide data about the effectiveness of lobeglitazone, the novel thiazolidinedione (TZDs), in a real-world and clinical practice setting.
Methods: In a retrospective and observational study, data from 232 patients (mean age : 56±10 yr, male 55%) with a minimum 6 months of lobeglitazone therapy were analyzed, who visited Huh’s Diabetes Center from  Jan. 2016 to Dec. 2016, who gave complete information on all covariates.
Insulin sensitivity was directly assessed by short insulin tolerance test as a rate constant for plasma glucose disappearance (kitt, %/min) after intravenous injection of regular insulin (0.1U/kg).
Results: Mean baseline glycated hemoglobin (HbA1c) was 8.7 ± 1.3% and mean fasting glucose was 196.6 ± 55.8 mg/dl. After 6 months of treatment with lobeglitazone, we observed a change in HbA1c of -1.0 ± 0.9% and -36.8 ± 28.7 mg/dl in fasting glucose(p< 0.001). Compared to baseline, the lipid profile showed that TG level was decreased (-30.8 ± 100.6 mg/dL, p<0.001), HDL-cholesterol level was increased (+1.2 ± 10.1 mg/dL, p<0.001). The insulin sensitivity was significantly improved (+0.681 ± 1.115 %/min, P<0.001). In patients treated with lobeglitazone as an add-on therapy, a decrease of -1.04% in HbA1c (p < 0.001) and a decrease of -38.1 mg/dl in fasting glucose (p < 0.001) were observed. In patients switched from other antidiabetic drug, lobeglitazone induced a decrease of -0.85% in HbA1c (p<0.001) and a decrease of -33.6 mg/dl in fasting glucose (p< 0.001). The difference of efficacy was not noted according to the baseline characteristics(age, sex, BMI, c-peptide and kitt).
Conclusion: Our study confirms the effectiveness of lobeglitazone in a real-life and clinical practice setting.

The clinical effect of lobeglitazone in poorly controlled type 2 diabetics with insulin resistance