In addition, patients receiving a higher cumulative defined daily dose (cDDD) of pioglitazone and insulin had a higher risk of developing AD than patients using a lower cDDD of pioglitazone and insulin (aHR = 1.736, 1.852, and 2.365 for cDDD < 258, 258–713 and ≧ 714, respectively; all p < 0.05, Table 3). Here, INS is linked to Alzheimer disease.