title: A retrospective review of thiazolidinediones with development of a troglitazone conversion protocol.
abstract: The objective of this paper was (1) to assess compliance with the National Veterans Affairs Guidelines for the use of troglitazone and rosiglitazone and (2) to develop and implement a conversion protocol that allows effective management of patients receiving troglitazone. A retrospective chart review was conducted to assess adherence to guidelines for all patients receiving troglitazone and rosiglitazone at the medical center. Appropriateness of therapy through indication evaluation, safety through alanine aminotransferase (ALT) monitoring compliance, and efficacy through hemoglobin A1c (HbA1c) changes were used to assess adherence. According to National Veterans Affairs (VA) Guidelines, 68% of troglitazone and 63% of rosiglitazone patients had an appropriate indication for the use of these agents. Baseline ALT levels were obtained in 40% of troglitazone and 71% of rosiglitazone patients. Full compliance with continual ALT monitoring was seen in 6 and 54% of patients, respectively. Goal HbA1c was achieved in 57 and 29% of patients, respectively. Of the 33 patients receiving troglitazone, 19 were converted to rosiglitazone therapy; 11 were maintained on current regimens without troglitazone, and 3 were lost to follow up. Adherence to guidelines needs to be reinforced, in particular, compliance with ALT monitoring. However, there were no reported cases of hepatotoxicity in the patients reviewed. Many patients did not achieve a HbA1c < 8% on either agent. Development of the protocol allowed for efficient conversion of the patients" diabetes regimen while safely identifying those that should remain on this class of medication.
authors.affiliation: University of Missouri-Kansas City School of Pharmacy, MO 64108, USA. Lindseyca@umkc.edu
authors.forename: Cameron
authors.initials: C
authors.lastname: Lindsey
authors.forename: Maqual
authors.initials: M
authors.lastname: Graham
authors.forename: Julie
authors.initials: J
authors.lastname: McMurphy
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D002839:Chromans / Q000008:administration & dosage / Q000627:therapeutic use*; D002985:Clinical Protocols; D000075202:Contraindications; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods / Q000592:standards; D017723:Drug Utilization Review; D019983:Guideline Adherence; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000639:trends; D012189:Retrospective Studies; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D000077288:Troglitazone; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D002839:Chromans; D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077154:Rosiglitazone; D000410:Alanine Transaminase; D000077288:Troglitazone