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In the October issue of Prescrire International:
No glitazones for diabetic patients!

FREE DOWNLOAD There are still no data conclusively demonstrating that glitazones prevent clinical complications of diabetes. An increased risk of adverse effects has been confirmed in patients treated with pioglitazone. There is no justification for adding a glitazone to insulin in the treatment of type 2 diabetes.
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Abstract

  • In patients with type 2 diabetes treated with insulin, adding metformin improves the glycated haemoglobin (HbA1c) level and reduces weight gain, without increasing the risk of hypoglycaemia.
  • According to the Summaries of Product Characteristics (SPC), glitazone in combination with insulin used to be contraindicated because of an increased risk of heart failure. This contraindication was removed in 2007.
  • Yet there are still no data conclusively demonstrating that glitazones prevent clinical complications of diabetes.
  • In contrast, an increased risk of adverse effects due to water-sodium retention, including heart failure, weight gain and peripheral oedema, has been confirmed in patients treated with pioglitazone plus insulin rather than with insulin alone. There have been similar reports in patients treated with rosiglitazone plus insulin.