Thiazolidinediones (TZDs for short), like Actos (generic: pioglitazone), are add-on diabetes medications that help lower blood sugar when first-line options aren’t a good fit or when treatment needs to be stepped up.TZDs work for other conditions too. Let’s take a closer look at how TZDs work to manage diabetes, who they’re best suited for, and what to consider with these medications.

What does this medication do?

With type 2 diabetes, the body has trouble using insulin properly. TZDs (like pioglitazone) help your body use insulin more effectively to lower blood sugar.Think of your cells like engines that need fuel (sugar). Think of insulin as a key and your cells as doors. With insulin resistance, the doors are hard to open. TZDs help ‘oil the hinges,’ so the doors open easily and insulin can get into work.

Who usually takes it?

• People with pre-diabetes
• People with type 2 diabetes
• People with fatty liver conditions – newly named Metabolic Dysfunction–Associated Fatty Liver Disease (MAFLD) and Metabolic Associated Steatohepatitis (MASH)

How do you take it?

TZDs are taken in pill form and can be taken with or without food. They’re generally started at 15 mg and increased by increments of 15, and max out at 45 grams daily.

Common side effects & considerations

Common side effects include headache, mild upper respiratory infections, and weight gain. More serious side effects include heart failure, fracture risk, and bladder cancer (Takeda Pharmaceuticals America, Inc., 2025). As a result, TZDs are not prescribed for people with heart failure. Weight changes and swelling should be monitored closely and reported to your healthcare provider as soon as possible if observed.

Affordability & Efficacy

TZDs like, Actos, are an affordable option in comparison to newer diabetes medications and can reduce A1c by 0.5-1.0%. Those are meaningful results without breaking the bank.

Tips for success

• Take your medicine once daily, with or without food, exactly as prescribed.
• Check your blood sugar regularly and watch for swelling, weight gain, or shortness of breath.
• Eat a balanced diet and stay active to help the medicine work better.
• Keep your doctor’s appointments and get labs as scheduled to stay safe.

Lifestyle habits that mimic or support medication action

• Move your body – walk, stretch, or do light exercise.
  Why: Exercise helps your muscles use sugar from your blood, which lowers blood sugar naturally.
• Eat balanced meals – include whole grains, vegetables, protein, and healthy fats.
  Why: Balanced meals slow sugar absorption and prevent spikes in blood sugar.
• Spread meals/snacks – eat 3 meals and small snacks if needed.
  Why: Eating regularly prevents long gaps that can cause your liver to release extra sugar.
• Maintain a healthy weight – small changes make a big difference.
  Why: Losing weight can make your body more sensitive to insulin, helping your medicine work better.
• Stay hydrated – drink water, limit sugary drinks.
  Why: Water helps your body process sugar and supports kidney and heart health.

Takeaways

• TZDs (like pioglitazone/Actos) help your body use insulin better.
• These medications may be used for type 2 diabetes, pre-diabetes, and fatty liver conditions such as MAFLD/MASH.
• They come as a daily pill and can be taken with or without food.
• Common side effects include headache, mild infections, and weight gain; serious risks include swelling, heart failure, fractures, and bladder cancer—so monitoring is important.
• They’re affordable and can lower A1c by about 0.5–1%.
• Healthy habits boost effectiveness: regular movement, balanced meals, eating consistently, staying hydrated, and small steps toward weight management all help your body respond better to insulin.
• Check blood sugars and follow up with your care team to make sure the medication is safe and working well for you.