The TOSCA.IT Trial: A Study Designed to Evaluate the Effect of Pioglitazone Versus Sulfonylureas on Cardiovascular Disease in Type 2 Diabetes

The recently published American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) position statement on the management of hyperglycemia in type 2 diabetes (T2D) (1) underlines the complexity of the therapeutic approach in T2D. This is due to both the increasing number of available drugs and to the paucity of solid data on the superiority of one compound over the others. By and large, antidiabetic drugs reduce blood glucose to a similar extent but have different impacts on cardiovascular (CV) risk factors, durability of efficacy, safety, and possible added values (2–4). A major challenge for clinicians is to select treatments that are capable of achieving and maintaining glucose control for as long as possible while minimizing the risk of chronic complications, including cardiovascular disease (CVD). This goal should be pursued with minimal side effects (mainly hypoglycemia). Although there is agreement on …