Review Question - QID 109333

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Diabetes Drugs Glitazones (thiazolidinediones) Toxicity QID: 109333 (M1.EC.17.4800)

QID 109333 (Type "109333" in App Search)

A 37-year-old female presents to her primary care provider for a normal follow-up visit. Her past medical history is notable for poorly controlled type II diabetes mellitus despite good treatment adherence to oral medications. She has been trialed on metformin and glyburide but stopped them due to intolerable side effects. She was started on a new oral diabetes medication three months ago. Since starting the new medication, she has noticed slowly progressive swelling in her lower extremities. Her temperature is 99.2°F (37.3°C), blood pressure is 120/75 mmHg, pulse is 105/min, and respirations are 22/min. She has gained 10 pounds since her last visit. Physical examination reveals 1+ pitting edema in the bilateral legs. A hemoglobin A1c lab test is drawn. This patient’s symptoms are most likely attributable to which of the following medications?

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Glipizide

10%

12/122

Exenatide

2/122

Pioglitazone

79%

96/122

Pramlintide

3/122

Acarbose

4/122

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The patient in this vignette presents with lower extremity edema suggestive of thiazolidinedione (TZD) toxicity. Water retention and weight gain are adverse effects of TZDs.

TZDs such as pioglitazone and rosiglitazone are used as monotherapy in type II diabetes mellitus. Because water retention is a known toxicity of TZDs, they are contraindicated in patients with congestive heart failure due to the potential to induce a heart failure exacerbation. Hepatotoxicity is another important adverse effect of TZDs.

Incorrect Answers:
Answer 1: Glipizide is a second-generation sulfonylurea that is used in the treatment of type II diabetes mellitus. Hypoglycemia and weight gain are adverse effects of second-generation sulfonylureas.

Answer 2: Exenatide is a GLP-1 analog that is used in the treatment of type II diabetes mellitus. Adverse effects of GLP-1 analogs include GI upset, pancreatitis, and hypoglycemia.

Answer 4: Pramlintide is an amylin mimetic agent that is used in the treatment of types I and II diabetes mellitus. Toxicities include hypoglycemia and GI upset.

Answer 5: Acarbose is an alpha-glucosidase inhibitor that is used as monotherapy or in combination with other agents for type II diabetes mellitus. GI upset is a common toxicity of alpha-glucosidase inhibitors.

Bullet Summary:
Thiazolidinediones are used to treat type II diabetes but are associated with an increased risk of fluid retention, weight gain, hepatotoxicity, and heart failure exacerbation.

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