TZDs abd pre-diabetes

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How many of you guys are using TZDs in your pre-diabetics? I'm curious since it's still off label but with the DREAM trial and with the supposedly soon to be released ACTNOW trial coming out, the results seem hard to argue with.

good question. unfortunately for me, i had no pre-diabetic patients in my residency clinic, just diabetics. and now that i've finished residency, no more clinic for me.

i am curious as to what other people are doing though.

Janecobb
that is a great question.
The DREAM trial is interesting.
I guess I'd be more tempted to use Metformin in a prediabetic that pioglitazone.
I personally woudn't start someone on rosiglitazone right now, due to recent data suggesting increased risk of cardiovascular death. One difference between rosi and pioglitazone though, is that they do different things to the lipid profile (rosi does bad things, pio does good things) so perhaps pioglitazone is safer from a standpoint of cardiovascular risk.

I'm personally not a huge fan of the glitazones, though, since they cause edema and weight gain. Why not just use metformin? Who wants to cause weight gain in a prediabetic. They're already fat, most of them.

Great post though!

Originally Posted by dragonfly99

Janecobb
that is a great question.
The DREAM trial is interesting.
I guess I'd be more tempted to use Metformin in a prediabetic that pioglitazone.
I personally woudn't start someone on rosiglitazone right now, due to recent data suggesting increased risk of cardiovascular death. One difference between rosi and pioglitazone though, is that they do different things to the lipid profile (rosi does bad things, pio does good things) so perhaps pioglitazone is safer from a standpoint of cardiovascular risk.

I'm personally not a huge fan of the glitazones, though, since they cause edema and weight gain. Why not just use metformin? Who wants to cause weight gain in a prediabetic. They're already fat, most of them.

Great post though!

I don't think any of my pts at the moment could even afford a TZD anyways. But it is a tempting thought to help slow the progression to become diabetic and then swap to other oral hyperglycemics.

As far as the Avandia data, I'm more than a little skeptical about data myself. There was a decent discussion with some good points about the Avandia article here but the lipid profile point is a good one that I always seem to forget.

There is NO SUCH THING AS PRE-DIABETES!!! It is a street term used to scare patients out of eating abundant amounts of sugars. You are either diabetic or not. It's like being pre-pregnant...no such thing!!!!

There is no acknowledgment of that term in any recent official Internal Medicine or Endocrinology textbooks!!

Originally Posted by berdugo75

There is NO SUCH THING AS PRE-DIABETES!!!

The American Association of Clinical Endocrinologists as well as the American Diabetes Association would seem to disagree with you.

Originally Posted by berdugo75

There is no acknowledgment of that term in any recent official Internal Medicine or Endocrinology textbooks!!

It seems to me that I read this very terminology in chapter 338 of the newest Harrison's