Spence JD, et al. - In the Insulin Resistance Intervention After Stroke (IRIS) trial, researchers analyzed pioglitazone impact in patients with good adherence as well as pioglitazone intention-to-treat effects in prediabetes patients. Cardiovascular events and new-onset diabetes were significantly reduced in this post hoc analysis of 2,885 people with prediabetes enlisted in this randomized clinical trial. Overall mortality, cancer, and hospitalization were slightly lowered, severe bone fractures were slightly higher, and weight gain and edema were increased. In participants with good adherence, the association was bigger, with stroke/myocardial infarction 40% lower, stroke 33% lower, and new-onset diabetes 80% lower. In patients with stroke/transient ischemic attack and prediabetes, especially those with good adherence, pioglitazone can be effective for secondary prevention.