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Head-to-head evidence comparison — which supplement is right for you?
Metformin vs Pioglitazone (Actos): Metformin has the stronger overall evidence (4 vs 4/10); they're alternatives for manage blood sugar — the best pick depends on your goals. Take the 60-second quiz for a pick tailored to your goals.
Metformin wins 1 of 3 categories. Both are solid choices — the best pick depends on your specific goals.
Verdict
Mostly mechanism / observational
Top outcomes
Verdict
Mostly mechanism / observational
Top outcomes
Shared outcomes (1)
Outcomes where both Metformin and Pioglitazone (Actos) have evidence — compare verdict strength side-by-side.
Off-label longevity use mirrors diabetes dosing (commonly 500–1500 mg/day of extended-release with meals) under a clinician. Not an approved longevity regimen, and unnecessary in well-controlled non-diabetics without a clear rationale.
with-meals
Extended-release tablet
Off-label metabolic use mirrors diabetes dosing (e.g. 15–45 mg once daily) under a clinician. A prescription drug; not an approved longevity regimen.
morning
Oral tablet (pioglitazone)
Weeks
Years
Weeks of training
Days (GI) to years (B12)
Weeks to months
Months to years
Months
Throughout use
Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group.
Lancet (London, England) (1998) · Rct · n=753
UKPDS 34 randomized trial of metformin in overweight type-2 diabetics
Metformin reduces all-cause mortality and diseases of ageing independent of its effect on diabetes control: A systematic review and meta-analysis.
Ageing research reviews (2017) · Meta analysis
Systematic review/meta-analysis of metformin and age-related outcomes
Metformin as a Tool to Target Aging.
Cell metabolism (2016) · Review
Review of metformin's aging-relevant mechanisms (AMPK, insulin/IGF-1, inflammation)
Pioglitazone after Ischemic Stroke or Transient Ischemic Attack.
The New England journal of medicine (2016) · Rct · n=3876
IRIS randomized trial in patients with insulin resistance but no diabetes after recent stroke/TIA (n=3,876)
Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial.
Lancet (London, England) (2005) · Rct · n=5238
PROactive randomized trial in high-cardiovascular-risk type 2 diabetics (n=5,238)
Long-Term Pioglitazone Treatment for Patients With Nonalcoholic Steatohepatitis and Prediabetes or Type 2 Diabetes Mellitus: A Randomized Trial.
Annals of internal medicine (2016) · Rct
Randomized, placebo-controlled trial of long-term pioglitazone in NASH with prediabetes/type 2 diabetes
Metformin has a higher evidence score (4/10 vs 4/10) and wins in 1 of 3 categories.
For manage blood sugar, Metformin has a higher relevance score (72 vs 62).
No known interactions between Metformin and Pioglitazone (Actos) have been documented in our database. However, always consult a healthcare provider before combining supplements.
The right pick depends on your goals. Answer a few quick questions for a personalised recommendation — or dig into the full evidence on each.