title: Treatment with a thiazolidinedione increases eye protrusion in a subgroup of patients with type 2 diabetes.
abstract: OBJECTIVE
  Changes in eye protrusion in patients treated with pioglitazone.
  
  
  METHODS
  Open-label prospective.
  
  
  METHODS
  Thirty-six patients with type 2 diabetes and HbA1c >or= 6.5% were included in a study where pioglitazone was added to current therapy with metformin and sulphonylurea.
  
  
  METHODS
  The degree of eye protrusion before and 26 weeks after treatment with pioglitazone was measured using Krahn's exophthalmometer.
  
  
  RESULTS
  Thirteen patients (group A) exhibited an increase of >or= 2 mm and 23 patients (group B) exhibited an increase of < 2 mm (P (between groups) = 0.036). Patients of group A vs. group B had the same BMI, HbA1c and mean doses of pioglitazone, but had lower levels (mean +/- SD) of adiponectin in microg/ml at the start (4.9 +/- 2.1) vs. (7.1 +/- 2.5), P = 0.017 and at the end of study (10.2 +/- 4) vs. (14.9 +/- 5), P = 0.007. Patients with thyroid disturbance were more frequent in group A (five vs. one), P = 0.02. In a logistic regression analysis, thyroid disturbance, low adiponectin levels and pioglitazone dose predicted a significant change in eye protrusion.
  
  
  CONCLUSIONS
  A subgroup of patients with type 2 diabetes treated with pioglitazone responded with increased eye protrusion. This subgroup showed decreased plasma concentration of adiponectin and more frequent thyroid disturbance, and was treated with higher doses of pioglitazone. The relationship between insulin resistance, thyroid disturbance and thiazolidinedione-induced eye protrusion should be further studied.
authors.affiliation: Department of Clinical Sciences, Division of Diabetes & Endocrinology, Lund University, Malmö University Hospital, Sweden. mozhgan.dorkhan@med.lu.se
authors.forename: Mozhgan
authors.initials: M
authors.lastname: Dorkhan
authors.forename: Mikael
authors.initials: M
authors.lastname: Lantz
authors.forename: Anders
authors.initials: A
authors.lastname: Frid
authors.forename: Leif
authors.initials: L
authors.lastname: Groop
authors.forename: Bengt
authors.initials: B
authors.lastname: Hallengren
mesh_terms: D052242:Adiponectin / Q000097:blood; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005094:Exophthalmos / Q000097:blood / Q000139:chemically induced*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007333:Insulin Resistance; D016015:Logistic Models; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D000077205:Pioglitazone; D011446:Prospective Studies; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D052242:Adiponectin; D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D008687:Metformin; D000077205:Pioglitazone