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Management of an Adult With Type 2 Diabetes With Antidiabetic Medications: A Case Scenario

Slide: 16 of 26

Patient Discussion: Thiazolidinediones

In response to this discussion about thiazolidinediones you review the evidence from the clinician research summary titled Comparing Medications for Adults With Type 2 Diabetes and tell him:

Discussion of Answers:

A. Incorrect. Explanation: According to current evidence of moderate strength, pioglitazone and rosiglitazone achieve a similar reduction in HbA1c by about 1 absolute percentage point.

B. Correct. Explanation: In September 2010, the FDA announced restrictions on prescribing rosiglitazone, due to a series of investigations suggesting an increased risk of ischemic cardiac events associated with its use.  If a patient has not previously been prescribed rosiglitazone, it can be prescribed only if there are medical reasons not to take pioglitazone and if the other classes of diabetes medications have not brought satisfactory control of blood glucose.  Patients already using rosiglitazone need to be informed about the cardiac risks of this drug.

C. Incorrect. Explanation: While it is likely rosiglitazone and pioglitazone are similar in glycemic reduction and for most side effects, including weight gain, edema, and fracture, there is evidence that rosiglitazone but not pioglitazone is associated with an increased risk of myocardial infarction. In September 2010, the FDA announced restrictions on prescribing rosiglitazone, due to a series of investigations suggesting an increased risk of ischemic cardiac events associated with its use.  If a patient has not previously been prescribed rosiglitazone, it can be prescribed only if there are medical reasons not to take pioglitazone and if the other classes of diabetes medications have not brought satisfactory control of blood glucose.  Patients already using rosiglitazone need to be informed about the cardiac risks of this drug.

D. Incorrect. Explanation: There is not enough evidence to determine if rosiglitazone is associated with a higher incidence of liver function abnormalities than pioglitazone.