Interactive diabetes case 17: A 47-year-old patient with newly discovered type 2 diabetes – A4

ANSWER — Incorrect.

Pioglitazone, a thiazolidinedione, is not an appropriate medication for the treatment of newly diagnosed type 2 diabetes or for use as a second or third oral agent. (See "Initial management of hyperglycemia in adults with type 2 diabetes mellitus".)

The thiazolidinediones bind to and modulate the peroxisome proliferator-activated gamma (PPAR-gamma) receptor, a transcription factor, and sensitize patients to the action of insulin. They reduce the glycated hemoglobin (A1C) value by 0.5 to 1.4 percent when used as monotherapy. (See "Thiazolidinediones in the treatment of type 2 diabetes mellitus".)

The thiazolidinediones are difficult to use because their effect on glucose levels and A1C values may not be apparent for two to three months. The thiazolidinediones cause weight gain and fluid retention. They should not be used in patients with a history of congestive heart failure or renal insufficiency. Pioglitazone causes an increased risk of fractures of the upper arms, hands, and feet in female patients with diabetes and may be associated with an increased risk of bladder cancer. Rosiglitazone, another agent in the same class, may cause an increased risk of myocardial infarction. For all these reasons, thiazolidinediones are not recommended for the initial pharmacologic treatment of diabetes. (See "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects'.)

Return to the beginning to try again. (See "Interactive diabetes case 17: A 47-year-old patient with newly discovered type 2 diabetes".)