Oral hypoglycaemics

Question 1

Thiazolidinediones (Pioglitazone)

Answer 1

Thiazolidinediones are a 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 Rosiglitazone was withdrawn in 2010 following concerns about the cardiovascular side-effect profile.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. It’s natural ligands are free fatty acids and it is thought to control adipocyte differentiation and function.

Question 2

Thiazolidinediones (Pioglitazone) ADRs

Answer 2

• 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 shown an increased risk of bladder cancer in patients taking pioglitazone (hazard ratio 2.64)