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- July 4, 2008 |
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"What are some of the clinical management issues with TZDs in regard to associated weight gain, fluid retention, and CHF?"Dr. Andrew P. Selwyn (biography)
English - 2004-06-04 - 14 minutes
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Summary :
Edema is most likely to occur when combining a TZD with insulin. Edema is however not unique to TZDs and the glycaemic and potential cardiovascular benefits of TZDs may outweigh the risk of weight gain and fluid retention.
Combination therapy of rosiglitazone added to glipizide showed an increase in the incidence of peripheral edema and modest weight gain. Weight gain is however also observed with other treatment regimens. It has been shown that weight gain in patients taking a TZD can be avoided with dietary modifications.
The AHA/ADA Consensus statements indicate that TZDs are not recommended for patients with overt congestive heart failure (CHF), and patients on a TZD or combination therapy with a TZD and insulin should be observed for signs and symptoms of heart failure. The incidence of CHF is less than 1 percent with TZD monotherapy.
Rosiglitazone and pioglitazone are not associated with major disturbances in liver function, and this is reflected in the revised liver monitoring recommendations when using these drugs.
Copyright © 2004 E-MedHosting.com Inc.
Learning objectives :
After viewing these slides the participant will be able to discuss:
-The incidence of edema and weight gain in patients on TZD monotherapy versus combination therapy
-The AHA/ADA Consensus Statement for TZDs
-Liver function with the use of newer generation TZDs
Bibliographic references :
Vivian Fonseca MD.Effect of thiazolidinediones on body weight in patients with diabetes mellitus Am J of Med.2003;115(8)suppl1:42-48.
Norman K. Hollenberg MD, PhD.Considerations for management of fluid dynamic issues associated with thiazolidinediones The American Journal of Medicine.2003;115(8)suppl 1:111-115.
Harold E. Lebovitz.Differentiating members of the thiazolidinedione class: a focus on safety Diabetes Metab Rev.2003;18(S2):S23 - S29.
Richard W. Nesto, MD, David Bell, MD, Robert O. Bonow, MD, Vivian Fonseca, MD, Scott M. Grundy, MD, PHD, Edward S. Horton, MD, Martin Le Winter, MD, Daniel Porte, MD, Clay F. Semenkovich, MD, Sidney Smith, MD, Lawrence H. Young, MD and Richard Kahn, PHD.Thiazolidinedione Use, Fluid Retention, and Congestive Heart Failure Diabetes Care. 2004;27:256-263.
Van Gaal LF, De Leeuw IH.Rationale and options for combination therapy in the treatment of Type 2 diabetes. Diabetologia 2003;46 Suppl 1:M44-50.
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