Endocrine Abstracts

Aim: To compare the use of glitazones against NICE guidelines. (Glitazone recommended as second line therapy in combination with metformin or sulfonyl urea in patients with intolerance or contra-indications to any of the two, not as monotherpay or triple therapy or in combination with insulin).

Methods: Patients on glitazone therapy (n=60) were randomly identified from a pharmacy data base from August to December 2006. Retrospective case note review and computer review of biochemical parameters were done in 35 patients in whom date of initiation of glitazone therapy by hospital or primary care physician was mentioned in case notes.

Results: Five patients were above 80 years of age, 17 were between 60–80 years and 13 were 40–60 years of age. Ten had retinopathy, 6 had nephropathy and 10 patients had ischemic heart disease. 20 patients were on rosiglitazone and 15 on pioglitazone. Thirty-two were on combination therapy-18 were on glitazone+metformin, 7 on glitazone+sulfonyl urea.

Two were on glitazone+insulin, 3 were on triple therapy and 3 on glitazone monotherapy (not in compliance with NICE guidelines).

Improvement in glycemic control (HbA1c) was <1.4% in 24 patients, 1.5–2% in 6, 2–3% in 5 patients. Worsening of liver functions was not observed in any patient. Three patients who had clinical and echocardiographic evidence of cardiac failure were started on glitazones which were subsequently discontinued because of exacerbation of cardiac failure. Three developed new onset cardiac failure while on glitazones out of which 2 had underlying evidence of ischemic heart disease.

Conclusions: Use of glitazones was not according to national guidelines in 11 patients within hospital and primary care. Three patients developed CCF while on glitazones and 3 had worsening of cardiac failure.

Recommendations: Increasing awareness about indications and contra-indications of glitazone therapy is needed.