Background: Pioglitazone is widely prescribed oral hypoglycaemic thiazolidinediones acting through Peroxisome Proliferators Activated Receptor gamma (PPAR ÃÂ´) as agonist. Apart from potent anti-hyperglycaemic action by improving insulin sensitivity, it also has positive effects on lipid metabolism and endothelial function. Controversies about use of Pioglitazone have been raised with regard to risk of bladder cancer. Hence recently drug was banned in India, but again ban was revoked for its use with special precautions. So there is a lot of debate about benefit to risk ratio of this drug. With this background we are presenting a case of carcinoma of urinary bladder developed in type 2 diabetes mellitus (T2DM) patient who was receiving Pioglitazone for glycemic control. Case presentation: A 65 year old man was admitted to our centre for tumor in urinary bladder. He was diagnosed as a case T2DM 8 year’s back at his village and started therapy with Metformin. After 2 years Pioglitazone was added for glycemic control. He received Pioglitazone in combination with Metformin for 6 years and then diagnosed urinary bladder cancer. First we shifted him from Pioglitazone to Mixtard Humiinsulin therapy. We managed him by transurethral resection of bladder tumour followed by 6 cycles of intravesical Mitomycin 40 mg weekly chemotherapy regimen. After completion of total treatment he is in remission period for 11 months. Conclusion: To study long term safety of Pioglitazone, large population based prospective studies are required. But till that time physicians should pay careful attention to assess the possibility of bladder cancer in patients receiving Pioglitazone.