Thiazolidinediones for Type 2 Diabetes
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Questions and Answers

What is the primary mechanism of action of thiazolidinediones in managing type 2 diabetes?

  • Stimulating glucagon secretion
  • Enhancing renal excretion of glucose
  • Reducing insulin resistance in muscle, liver, and fat tissues (correct)
  • Increasing insulin production from the pancreas

    • Which side effect is most commonly associated with the use of thiazolidinediones?

  • Edema (correct)
  • Nausea
  • Hypoglycemia
  • Diarrhea

    • How do pioglitazone and rosiglitazone differ in their effects on triglycerides and LDL cholesterol?

  • Pioglitazone decreases triglycerides while rosiglitazone has no effect (correct)
  • Both drugs reduce LDL cholesterol levels
  • Both drugs increase triglycerides significantly
  • Rosiglitazone decreases triglycerides more than pioglitazone

    • What is the maximum expected reduction in A1C levels from thiazolidinedione therapy?

    <p>1%–1.5%</p> Signup and view all the answers

    What type of patients should avoid thiazolidinediones due to their risk of heart failure?

    <p>Patients with Class III or IV heart failure</p> Signup and view all the answers

    Which statement best describes the recommended usage of thiazolidinediones in diabetes treatment?

    <p>They are typically used in combination with other antidiabetic medications</p> Signup and view all the answers

    What potential long-term risk is associated with the use of pioglitazone?

    <p>Increased risk of bladder cancer</p> Signup and view all the answers

    What is a noted impact of thiazolidinediones on weight?

    <p>Weight gain attributed to fluid retention and fat accumulation</p> Signup and view all the answers

    What is the recommended dosing frequency for thiazolidinediones?

    <p>Once daily</p> Signup and view all the answers

    What common side effect of thiazolidinediones may require dose reduction?

    <p>Peripheral edema</p> Signup and view all the answers

    Study Notes

    Thiazolidinediones (TZDs) for Type 2 Diabetes

    • Mechanism: TZDs reduce insulin resistance by enhancing insulin sensitivity in muscle, liver, and fat tissues. This improves glycemic control.
    • Examples: Pioglitazone and Rosiglitazone
    • Efficacy: Both drugs can decrease A1C by 1-1.5% and fasting plasma glucose (FPG) by 60-70 mg/dL (3.3-3.9 mmol/L). Effects are typically seen after 4-6 weeks.
    • Dosage: Taken orally once daily, with or without food.
    • Use: Often used as a second or third-line treatment combined with other type 2 diabetes medications like metformin.
    • Common Side Effects: Edema, heart failure, osteoporosis.

    Drug Specific Effects

    • Pioglitazone: Reduces triglycerides (TG) by 10-20% and does not significantly raise LDL cholesterol. Increases HDL cholesterol.
    • Rosiglitazone: May increase LDL cholesterol by 5-15% and has neutral effects on triglycerides. Increases HDL cholesterol, less pronounced than pioglitazone.
    • Warnings: Both drugs increase risk of heart failure and require caution in patients with pre-existing heart conditions. Rosiglitazone has a specific black box warning about increased risk of myocardial infarction (MI).

    Important Considerations

    • Fluid Retention: TZDs can cause fluid retention due to peripheral vasodilation and increased sodium and water retention by the kidneys. Edema is dose-related and may be managed by reducing the dosage. Diuretics may be needed in severe cases. 4-5% of patients with monotherapy and 15% or more when combined with insulin.

    • Heart Failure: TZDs are contraindicated (CI) in patients with Class III or IV heart failure. Use with caution in those with Class I or II heart failure (black box warning).

    • Weight Gain: Dose-dependent weight gain, from both fluid retention and fat accumulation. A 4 kg gain is common and may necessitate discontinuation of the medication in some cases.

    • Bone Health: Increased fracture risk, particularly in postmenopausal women, due to reduced bone density.

    • Bladder Cancer: A controversial link exists regarding increased risk of bladder cancer, particularly with pioglitazone. Should not be used in patients with active bladder cancer.

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    Description

    Explore the use of Thiazolidinediones (TZDs) in managing Type 2 Diabetes through their mechanism, efficacy, and specific drug effects. This quiz covers important medications like Pioglitazone and Rosiglitazone, detailing their benefits, dosages, and common side effects. Test your knowledge on these medications and their impact on glycemic control.

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