Glitazone use associated with diabetic macular edema.
OBJECTIVE
To determine the ocular safety of glitazones in patients with diabetes, we investigated the association of diabetic macular edema (DME) in a large population of glitazone users.


METHODS
Prospective cohort study.


METHODS
The study was conducted at Kaiser Permanente Southern California. About 170,000 persons with diabetes were identified using the Diabetes Case Identification Database. Glitazone drug use was obtained from the pharmacy database. The main outcome measure was the development of macular edema (ME). The chi2 test was used to compare proportions and t tests were used for means. Logistic regression analysis was used to adjust for potential confounding variables.


RESULTS
In 2006, there were 996 new cases of ME. Glitazone users were more likely to develop ME in 2006 (odds ratio [OR], 2.6; 95% confidence interval [CI], 2.4 to 3.0). After excluding patients who did not have the drug benefit, did not have an eye exam, and had a HgA1c <7.0, glitazone use was still associated with an increased risk of developing ME (OR, 1.6; 95% CI, 1.4 to 1.8).


CONCLUSIONS
The current study appears to show that the glitazone class of drug is associated with DME. After adjusting for confounding factors of age, glycemic control, and insulin use, glitazones are still modestly associated with DME. A more in-depth study will need to be done to evaluate the role of other confounding factors. When treating patients with DME, ophthalmologists should consider the role of the glitazones.
Fong
Donald S
DS
Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California and Clinical Trials Research, Pasadena, California 91101, USA. donald.s.fong@kp.org
Contreras
Richard
R
D000328:Adult; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D003930:Diabetic Retinopathy / Q000139:chemically induced* / Q000453:epidemiology / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D015994:Incidence; D008269:Macular Edema / Q000139:chemically induced* / Q000453:epidemiology / Q000378:metabolism; D008875:Middle Aged; D047495:PPAR gamma / Q000819:agonists / Q000378:metabolism; D000077205:Pioglitazone; D011446:Prospective Studies; D012307:Risk Factors; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000009:adverse effects*
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D047495:PPAR gamma; D000077205:Pioglitazone; D000077154:Rosiglitazone; D045162:Thiazolidinediones