In July 2010, Takeda launched an aggressive ad campaign proclaiming that its leading diabetes medication, pioglitazone, was far safer than its rival, rosiglitazone. The ad stated, “Actos lower[s] blood sugar without increasing your risk of having a heart attack or stroke.”1 This may be true, but just because pioglitazone might be safer than rosiglitazone does not mean it is the safest and most effective treatment choice. For many patients currently taking rosiglitazone, simply switching to another thiazolidinedione (TZD) such as pioglitazone is not necessarily the best option.