Background:  “Asian Indian Phenotype” refers to certain unique clinical and biochemical abnormalities in Indians which include increased insulin resistance, greater abdominal adiposity i.e., higher waist circumference despite lower body mass index, lower adiponectin and higher high sensitive C-reactive protein levels. Insulin sensitizers like Pioglitazone is especially valued in the Asian–Indian patients because of high level of insulin resistance.
Aims and objective: To evaluate the effect of pioglitazone withdrawal in type 2 diabetes mellitus patients.
Materials and Methods:  A retrospective multicentre observational study on 100 T2DM patients who were well controlled on pioglitazone either as mono, dual or triple therapy was done from year of 2010 to 2016.  Detailed history was recorded in prescribed format. 50 patients withdrew pioglitazone after hearing pioglitazone ban, 20 have withdrawn because of their own decision, 10 withdrawn because of pioglitazone related side effects and rest 20 patients had miscellaneous reasons to withdraw pioglitazone. The pioglitazone withdrawal patients were up titrated by mono to dual, dual to triple and basal with bolus therapy in next  10 months. In spite the target glycemia was not achieved. So, in pioglitazone withdrawal 70 patients low dose pioglitazone (7.5 mg) was added to control blood glucose. Characteristics including demographics and glycated hemoglobin (HbA1c) were recorded at baseline and at three months.
Results: Patient preponderance was recorded with mean HbA1c before withdrawn of pioglitazone, 3 months after withdrawal of pioglitazone and at 10 months after starting additional drugs was 6.65±0.24, 9.65±1.21 and 8.52±1.75   (p<0.001). Mean HbA1c after the addition of low dose pioglitazone and additional drugs was 7.12±0.56%.
Conclusion: Despite the up titration of therapy target HbA1c was not achieved without adding low dose of pioglitazone hence, we were able to confirm our hypothesis of necessity of insulin sensitizer like pioglitazone in Indian population.

Effect of pioglitazone withdrawal in type 2 diabetes mellitus patients