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

Slide: 14 of 26

Patient Discussion: Other Treatment Options

The patient says he has heard that pioglitazone has additional benefits that could reduce his risks of cardiovascular complications to a greater extent than metformin, so why not prescribe pioglitazone for him?  You tell him:

Discussion of Answers:

A. Incorrect. Explanation: All of these options are correct. In fact, low strength evidence suggests that thiazolidinediones are associated with higher rates of congestive heart failure than metformin monotherapy.

B. Incorrect. Explanation: All of these options are correct. There is moderate strength of evidence that metformin is associated with lower LDL than pioglitazone by 14.2 mg/dL.

C. Incorrect. Explanation: All of these options are correct. There is high strength of evidence that metformin maintains or decreases body weight when compared to thiazolidinedione monotherapy by -2.6 kg.

D. Correct. Explanation: All of these options are correct. Both pioglitazone and metformin have small effects on the lipid profile.  Metformin decreases LDL-C about 14 mg/dL more than pioglitazone (moderate strength of evidence), while pioglitazone decreased triglycerides about 27 mg/dL more than metformin (high strength of evidence).   In most diabetics with dyslipidemia, these effects are not sufficient to attain recommended targets for lipid lowering. Also, there is high strength of evidence that metformin maintains or decreases body weight when compared to thiazolidinedione monotherapy by -2.6 kg.