Up to 40 percent of type 2 diabetes patients currently taking thiazolidinediones (TZD) have evidence of heart failure (HF) and therefore should not be candidates for TZD therapy, according to a study published recently in Circulation: Heart Failure. TZDs can cause fluid retention, which is associated with an increased HF risk.

Using data from ACC and Veradigm's Diabetes Collaborative Registry, Suzanne V. Arnold, MD, MHA, et al., examined the proportion of patients taking TZDs according to patient characteristics and over time. Among 424,061 U.S. adults with type 2 diabetes taking at least one glucose-lowering medication, 35,018 patients (8.3 percent) were taking a TZD. In addition, TZD use gradually increased over time, from 7 percent in 2013 to 8.9 percent in 2016. Patients taking TZDs were more likely to be older and to have coronary disease (61.9 percent) and class 3 obesity (17.2 percent). Overall, 40.3 percent of patients taking TZD had a clinical diagnosis of HF (23.7 percent), had ejection fraction of less than 40 percent (7.7 percent), or were taking a loop diuretic (29.9 percent).

According to the researchers, TZD use "remains notable and may be slightly increasing over time," with at least one-quarter and up to 40 percent of patients on TZDs showing evidence of HF. The authors conclude that moving forward, additional research identifying the ideal candidates for TZDs is needed, along with continued education about the need to avoid TZD in patients with HF.

Keywords: Thiazolidinediones, Diabetes Mellitus, Type 2, Sodium Potassium Chloride Symporter Inhibitors, Glucose, Stroke Volume, Heart Failure, Edema, Coronary Artery Disease, Registries, National Cardiovascular Data Registries, Diabetes Collaborative Registry, Obesity

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