Management of an Adult With Type 2 Diabetes With Antidiabetic Medications: A Case Scenario
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.
Keywords: adverse effects | pioglitazone | body adipose stores | subcutaneous fat | adipocytes | weight gain
- Bennett WL, Wilson LM, Bolen S, et al. Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update. Comparative Effectiveness Review No. 27. (Prepared by Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018.) AHRQ Publication No. 11-EHC038-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2011. Available at: http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=644.
- Virtanen KA, Hallsten K, Parkkola R et al. Differential effects of rosiglitazone and metformin on adipose tissue distribution and glucose uptake in type 2 diabetic subjects. Diabetes 2003; 52(2):283-90.
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