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Understanding the contemporary use of thiazolidinediones. An analysis of the Diabetes Collaborative Registry

Session Poster Session 3

Speaker Associate Professor Suzanne Arnold

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Comorbidities
  • Session type : Poster Session

Authors : S Arnold (Kansas City,US), S Inzucchi (New Haven,US), J Echouffo-Tcheugui (Baltimore,US), F Tang (Kansas City,US), C Lam (Singapore,SG), L Sperling (Atlanta,US), M Kosiborod (Kansas City,US)

Authors:
S Arnold1 , S Inzucchi2 , J Echouffo-Tcheugui3 , F Tang1 , C Lam4 , L Sperling5 , M Kosiborod1 , 1St. Luke's Mid America Heart Institute - Kansas City - United States of America , 2Yale University - New Haven - United States of America , 3Johns Hopkins University of Baltimore - Baltimore - United States of America , 4Duke-NUS Graduate Medical School Singapore - Singapore - Singapore , 5Emory University School of Medicine - Atlanta - United States of America ,

Citation:

Background: Thiazolidinediones (TZDs; rosiglitazone, pioglitazone) are oral medications for type 2 diabetes (T2D) with unique benefits and risks. TZDs effectively reduce blood glucose with minimal risk of hypoglycemia and have potential beneficial effects on atherosclerosis. However, TZDs can cause fluid retention thereby increasing the risk of heart failure--a common complication of T2D.

Purpose: To examine the use of TZDs among patients in the Diabetes Collaborative Registry (DCR) according to patient characteristics and over time.

Methods: DCR is a US outpatient registry of T2D patients recruited from cardiology, endocrinology, and primary care practices and currently encompasses 203 practices and 3074 providers.

Results: Among 424,061 US adults with T2D who were taking =1 glucose-lowering medication, 35,018 patients (8.3%) were on a TZD, which has gradually increased over time (Figure). TZDs were most often used as a 2nd (28.4%) or 3rd drug (32.0%), with only 9.4% of patients on a TZD as monotherapy. Patients on TZDs tended to be older (mean age 69.2 ± 10.7 years), 61.9% had coronary disease, 14.8% with prior stroke, and 17.2% were morbidly obese (BMI >40 kg/m2). A clinical diagnosis of heart failure was present in 23.7% of patients on TZDs, 18.1% had left ventricular dysfunction (7.7% with EF <40%), and 29.9% were on a loop diuretic.

Discussion: Although TZDs lost significant market share in 2007-2010 when concerns arose regarding their safety, TZDs are still the 4th most used oral glucose-lowering medication in the DCR, and their use may be slightly increasing over time. It is not known if this trend relates to the low cost of these now generic drugs or emerging evidence of their cardiovascular benefits. At least a quarter of patients who are currently treated with TZDs in the DCR population have some evidence of heart failure and therefore should not be candidates for this therapy. Accordingly, heart failure concerns with TZDs may be under-recognized.

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