Key takeaways
Alogliptin (Nesina) and Pioglitazone (Actos) are both medications used to treat Type 2 diabetes, but they work in different ways and belong to different drug classes. Alogliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that helps your body keep insulin around longer and reduces sugar production, while pioglitazone is a thiazolidinedione that improves your body's ability to use insulin. Both medications are typically taken once daily, with or without food, and are available as lower-cost generics. Pioglitazone can cause weight gain and fluid build-up, which can lead to heart failure, while alogliptin doesn't significantly affect weight but may increase the risk of heart failure in those with a history of heart issues. Additionally, pioglitazone has been linked to a higher risk of bladder cancer and bone fractures, especially in women, whereas alogliptin may cause severe joint pain and rare cases of pancreatitis (inflammation of the pancreas) or liver problems. Both medications are not first-choice treatments for Type 2 diabetes.
