A 54-year-old woman with type 2 diabetes mellitus is reviewed. A decision is made to start thiazolidinedione therapy.
Which one of the following points is it most relevant to consider before starting treatment?
1.History of oesophageal problems
2.Fracture risk
3.History of depression
4.History of cardiac arrhythias
5.Visual acuity
Explanation
There is increasing evidence thiazolidinediones increase the risk of fractures
Thiazolidinediones
Thiazolidinediones are a new class of agents used in the treatment of type 2 diabetes mellitus. They are agonists to the PPAR-gamma receptor and reduce peripheral insulin resistance. Rosiglitazone was withdrawn in 2010 following concerns about the cardiovascular side-effect profile.
The PPAR-gamma receptor is an intracellular nuclear receptor. Its natural ligands are free fatty acids and it is thought to control adipocyte differentiation and function.
Adverse effects
weight gain
liver impairment: monitor LFTs
fluid retention - therefore contraindicated in heart failure. The risk of fluid retention is increased if the patient also takes insulin
recent studies have indicated an increased risk of fractures
bladder cancer: recent studies have showed an increased risk of bladder cancer in patients taking pioglitazone (hazard ratio 2.64