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Study Gives Elderly Diabetics Something New To Consider

Ruzanna Harutyunyan's picture

For patients with diabetes, thiazolidinediones (TDZs) are an oral treatment option for those who would otherwise have to resort to insulin shots to control their blood sugar levels. Researchers at Brigham and Women's Hospital (BWH) compared the outcomes of the two TDZs available on the market today and found that in the group of patients using rosiglitazone, there was a higher occurrence of death and a greater risk of congestive heart failure (CHF) in elderly patients, when compared with those using the other TDZ, pioglitazone. The findings appear in the issue of Archives of Internal Medicine.

Shortly after rosiglitazone and pioglitazone entered the market, it became apparent that both had important adverse effects, most importantly CHF. Previous study of the drugs yielded results suggesting an increased risk of CHF for both, and an increased risk of myocardial infarction (MI) for those using rosiglitazone,. In studies of pioglitazone, however, it was suggested that patients had a lower risk of MI or stroke as compared to those in the study that did not receive the drug.

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"Because there was limited data that directly compared the two drugs, we wanted to look specifically at the comparative risks of each," said Wolfgang Winkelmayer, of the Pharmacoepidemiology and Renal Divisions at BWH and lead author of the study. "We wanted to determine whether older patients should consider certain risks when deciding whether to take one drug over the other."

To examine the relative effects of rosiglitazone and pioglitazone, researchers looked at the medical information available for 28,361 Medicare beneficiaries aged 65 years and older who had diabetes and initiated treatment with one of the two TDZs.

After looking at the number of patients who died while on one of the drugs, researchers found that patients taking rosiglitazone were at a higher risk of death, with 15 percent greater mortality among patients using rosiglitazone. In addition, the occurrences of MI, stroke and CHF in patients were examined, and the group taking rosiglitazone exhibited a 13 percent greater risk of CHF. However, the study did not establish any differences in the risk of MI or stroke between the groups of patients taking the two drugs.

"This could be valuable information for elderly diabetic patients who are considering a TDZ, as well as for physicians prescribing these drugs to patients," said Dr. Winkelmayer.