|
Medical History
Previously, MP demonstrated elevated fasting plasma glucose (FPG) levels indicative of prediabetes (impaired fasting glucose [IFG]). At this visit, her FPG exceeds 126 mg/dL for the second time. She has a medical history of hypertension and dyslipidemia, and suffered a myocardial infarction (MI) 5 years previously (ejection fraction, 55%).
At this visit, you plan to start MP on an antidiabetic medication and are considering a TZD because of the positive effects on insulin resistance and cardiovascular parameters, such as lipids, blood pressure, and endothelial function. However, you are somewhat concerned over case reports regarding edema and CHF in patients using TZDs, and are unsure if her medical history would contraindicate this drug class.
Q: What is the risk for edema with the use of TZDs?
A: When used as monotherapy, TZDs have a 3% to 5% incidence of pedal edema. This rate is greater when TZDs are used in combination with other glucose-lowering agents and greatest when TZDs are used in combination with insulin (approximately 15%). This higher incidence in patients taking insulin may be partially explained by the fact that, in general, these patients are older and have had diabetes for many years. Thus, they are more likely to have hypertension, left ventricular hypertrophy, and a history of coronary artery disease—all of which are associated with the development of edema.1
| 
