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. 2025 Dec 10.
doi: 10.1007/s00592-025-02633-w. Online ahead of print.

Metabolic effects of pioglitazone and sodium-glucose cotransporter 2 inhibitors in familial partial lipodystrophy

Utku Soyaltin  1 , Ilgin Y Simsir  2 , Baris Akinci  3
Affiliations

Metabolic effects of pioglitazone and sodium-glucose cotransporter 2 inhibitors in familial partial lipodystrophy

Utku Soyaltin et al. Acta Diabetol. .

Abstract

Objective: We aimed to evaluate the potential metabolic benefits of pioglitazone, a PPARG agonist, and sodium-glucose cotransporter 2 (SGLT2) inhibitors in patients with familial partial lipodystrophy (FPLD).

Methods: This retrospective medical chart study included 38 adult patients with FPLD (18 treated with pioglitazone and 20 with SGLT2 inhibitors).

Results: Treatment with pioglitazone reduced HbA1c from 8.6% (6.2-9.2) to 7.0% (5.9-8.8) at month 6 (p = 0.004) and 7.0% (6.1-8.7) at month 12 (p = 0.107). Triglycerides decreased by 25% (6-55%) at month 6 (p = 0.001) and 16% (4-44%) at month 12 (p = 0.008). A modest reduction in ALT was observed at month 12 (p= 0.046). Treatment with SGLT2 inhibitors reduced HbA1c from 8.7% (7.9-10.2) at baseline to 8.1% (7.4-9.4) at month 6 (p = 0.003) and 7.9% (7.3-8.9) at month 12 (p = 0.003). Median triglyceride levels decreased by 11% (0-33%) at month 6 (p = 0.013), while changes at month 12 were not significant. No meaningful changes were observed in weight, ALT, or AST.

Conclusions: We observed modest metabolic improvements following treatment with pioglitazone and SGLT2 inhibitors in patients with FPLD.

Keywords: Inhibitors; Lipodystrophy; PPARG agonists; Sodium-Glucose Cotransporter 2.

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Conflict of interest statement

Declarations. Conflict of interest: BA attended advisory board meetings organized by Amryt Pharmaceuticals and Regeneron Pharmaceuticals and has served as a consultant and/or received honoraria as a speaker from Third Rock Ventures, Amryt, Regeneron, AstraZeneca, Lilly, MSD, Novartis, Novo Nordisk, Boehringer-Ingelheim, Servier, and Sanofi-Aventis. Other authors report no conflicts of interest. Ethical approval: This study was approved by the Institutional Review Board (IRB) of the Dokuz Eylul University Medical School Hospital (IRB; 7364 GOA) in accordance with the Declaration of Helsinki. The study involves prospectively collected data so informed consent was taken all of the study participants.

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