Which diabetes medication is associated with weight gain due to increased water retention?

Pioglitazone is associated with weight gain due to its pharmacological effects that lead to increased water retention. As a thiazolidinedione, pioglitazone works by improving insulin sensitivity in muscle and fat tissues, but it also acts on adipose tissue, which can promote fluid accumulation in addition to increasing the mass of adipose tissue. This is particularly important to recognize in the management of diabetes and obesity, as the weight gain associated with pioglitazone can counteract weight loss efforts in patients trying to manage their obesity alongside type 2 diabetes.

The weight gain is primarily related to fluid retention, and it is not uncommon for patients on pioglitazone to experience ankle swelling or edema as a result of this fluid retention. Such characteristics make pioglitazone distinct compared to other diabetes medications that do not share this side effect profile, highlighting the importance of considering both glucose management and weight-related outcomes when choosing diabetes medications for patients with obesity.