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

Slide: 22 of 26

Adverse Effects Associated With Pioglitazone

The most likely reason for the weight gain is:

Discussion of Answers:

A. Incorrect. Explanation: Incorrect. Pioglitazone does not cause an increase in appetite.

B. Correct. Explanation: Pioglitazone, like other thiazolidinediones, has a potent effect on the regulation of insulin sensitivity in adipocytes and pre-adipocytes, leading in some patients to a clinically evident increase in fat mass. Additionally, there is high strength of evidence that metformin maintains or decreases weight to a greater extent than thiazolidinediones (pooled between-group difference of -2.6 kg, 95% CI -4.1 kg to -1.2 kg), the combination of metformin plus a thiazolidinedione (pooled between-group difference of -2.2 kg, 95% CI -2.6 kg to -1.9 kg).

C. Incorrect. Explanation: In the absence of symptoms and clinical signs of heart failure, it is not necessary to initiate a detailed workup for heart failure in a patient who gains a moderate amount of weight on pioglitazone.

D. Incorrect. Explanation: This answer is incorrect. Pioglitazone does not have growth hormone-like effects.

E. Incorrect. Explanation: There is no known synergism between metformin and pioglitazone in regard to adipose weight gain.