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Glitazones stay as second line option for diabetes

Glitazones have kept their place as a second-line therapy in joint US and European guidance on type 2 diabetes but with new warnings on their use.

The American Diabetes Association and the European Association for the Study of Diabetes have published an updated treatment algorithm with the TZDs – along with sulphonylureas and insulin – as possible drug treatments after metformin. But they should be used in greater caution in patients with - or at risk of - heart failure.

Concerns over use of the drugs surfaced with the publication last year of an analysis of rosiglitazone data which suggested it was associated with an increase MI risk.

The new ADA/EASD statement states: 'At this time, we do not view as definitive the clinical trial data regarding increased or decreased risk of MI with rosiglitazone or pioglitazone, respectively.

'Nor do we think that the increased risk of congestive heart failure or fractures with either [drug] is of a magnitude to warrant their removal as one of the possible second- step medications in our algorithm, given that they cause hypoglycemia less frequently than other second step drugs.

'On the other hand, we do believe that the weight of the new information should prompt clinicians to consider more carefully whether to use this class of drugs versus insulin or sulphonylureas as the second step in the algorithm.'

The new document has been published in Diabetes Care. Read our recent Where Are We Now? article for diabetes GPSI Dr Brian Karet's analysis of the data.

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