Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-44

Rosiglitazone (Avandia) • TDD: 2 mg - 8 mg • Frequency: QD-BID • Administration: Taken with/without meal. Dosing schedule • Initiate with 2 mg QD or BID. • Titrate dose every 2–4 weeks. • Full BG-lowering effect seen within 6–12 weeks. • Available: 2 mg, 4 mg tabs

A meta-analysis showed that rosiglitazone use was associated with an increased risk of MI (1.43, 95% CI 1.03–1.98, p=0.03) (113). However, large RCTs do not show an increased risk of MI. Cautions • Not recommended in people with type 2 diabetes and a history of ischemic heart disease, and myocardial ischemic symptoms Prior to prescribing Avandia®, practitioners must: Document the following: • Counsel the individual on the risks and benefits of Avandia, including the CV risks. • Obtain the person’s written informed consent to take the drug. Avandia is only indicated in combination with metformin or a sulfonylurea. • Monitor for signs and symptoms of CHF (rapid weight gain, dyspnea, edema) after initiation. • Associated with increased risk of CHF and rare risk of bladder cancer. Contraindications • Active bladder cancer or a history of bladder cancer • Uninvestigated macroscopic hematuria

Pioglitazone (Actos®) • TDD: 15 mg - 45 mg • Frequency: QD • Administration: Taken with/without meal. Dosing schedule • Initiate with 15 mg QD. • Titrate dose every 2–4 weeks. • Full BG-lowering effect seen within 6-12 weeks. • Available: 15 mg, 30 mg, 45 mg tabs

Note: Troglitazone (Rezulin™) discontinued due to 43 reported cases of hepatic failure, causing 28 deaths and 7 transplants (107) A1C = glycated hemoglobin; ALT = alanine transaminase; BG = blood glucose; BMD = bone mineral density; BP = blood pressure; CHF = congestive heart failure; CV = cardiovascular; eGFR = estimated glomerular filtration rate; FBG = fasting blood glucose; FFA = free fatty acid; HDL-C = high-density lipoprotein cholesterol; IGT = impaired glucose tolerance; LDL-C = low-density lipoprotein cholesterol; LFT = liver function test; MI = myocardial infarction; NYHA = New York Heart Association; PCOS = polycystic ovarian syndrome; PPAR = peroxisome proliferators-activated receptor; TC = total cholesterol; TDD = total daily dose; TG = triglycerides; TZD = thiazolidinediones; ULN = upper limit of normal