title: Effectiveness and side effects of thiazolidinediones for type 2 diabetes: real-life experience from a tertiary hospital.
abstract: OBJECTIVE
  To assess effectiveness and side effects of thiazolidinediones (TZDs) as adjunctive therapy in suboptimally controlled patients with type 2 diabetes.
  
  
  METHODS
  Review of a prospectively recorded database at the Royal Melbourne Hospital diabetes clinic.
  
  
  METHODS
  203 patients with type 2 diabetes who received pioglitazone or rosiglitazone between 1 May 2000 and 31 October 2002.
  
  
  METHODS
  Response in glycohaemoglobin (HbA(1c)) level, lipid profile changes and side effects, including hypoglycaemia, weight gain, oedema and precipitation of cardiac failure.
  
  
  RESULTS
  Both pioglitazone and rosiglitazone improved glycaemic control, with a reduction in the HbA(1c) level of 1.02% (range, 0.85%-1.19%) and 0.96% (range, 0.81%-1.11%), respectively, in the first 6 months of therapy. Rosiglitazone was associated with a 0.45 mmol (range, 0.31-0.59 mmol) increase in cholesterol level and 0.99 mmol (range, 0.60-1.38 mmol) increase in triglyceride level, while pioglitazone was associated with insignificant declines in cholesterol and triglyceride levels. There was reduced requirement for insulin, but not for oral hypoglycaemic agent (OHA), in most patients who used these agents. Pioglitazone and rosiglitazone were associated with increased rates of hypoglycaemia (17% and 11% of patients, respectively), significant weight gain (48% and 58%) and oedema (33% and 21%). There were four cases of acute left ventricular failure and two cases of reversible liver dysfunction in patients treated with TZDs.
  
  
  CONCLUSIONS
  Adding pioglitazone or rosiglitazone therapy to OHA or insulin in patients with type 2 diabetes significantly improved glycaemic control. However, the use of these drugs in routine clinical practice was associated with more frequent adverse events than previously reported in clinical trials.
authors.affiliation: Royal Melbourne Hospital, Parkville, Vic.
authors.forename: Zanariah
authors.initials: Z
authors.lastname: Hussein
authors.forename: John M
authors.initials: JM
authors.lastname: Wentworth
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Nankervis
authors.forename: Joseph
authors.initials: J
authors.lastname: Proietto
authors.forename: Peter G
authors.initials: PG
authors.lastname: Colman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004487:Edema / Q000139:chemically induced; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D000077205:Pioglitazone; D012189:Retrospective Studies; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000627:therapeutic use*; D014280:Triglycerides / Q000097:blood
chemical_list: D002784:Cholesterol; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000077205:Pioglitazone; D000077154:Rosiglitazone; D045162:Thiazolidinediones; D014280:Triglycerides