Although uncommon, insulin resistance increases cardiovascular risk.
[en.wikipedia.org]
With a goal of increasing insulin sensitivity, pioglitazone has been shown to be more efficacious than metformin in this patient population.
[statpearls.com]
Whilst there is an increased risk of insulin resistance and metabolic complications (including menstrual irregularities, hirsutism, diabetes mellitus, dyslipidemia, hypertension
[orpha.net]