Mithal Ambrish, Kaur Parjeet, Bansal Beena, Mishra Sunil Kumar, Wasir Jasjeet S, Jevalikar Ganesh, Mahendru Shama
Department of Endocrinology, Medanta the Medicity, Gurgaon, Haryana, India.
Indian J Endocrinol Metab. 2014 Jan;18(1):111-2. doi: 10.4103/2230-8210.126588.
Pioglitazone improves glycemic control by acting as an insulin sensitizer and is used in the management of Type 2 diabetes mellitus. Pioglitazone has recently been at the center of a controversy with regards to its safety. There is no clear consensus on how, when and in what dose the drug should be used in the management of diabetes. We have summarized our strategy on pioglitazone use in Type 2 diabetes in a large private tertiary care center - Medanta, the Medicity- which may help in generating further thought about positioning of this anti-diabetic molecule. We use pioglitazone as the fourth in the pecking order of oral anti-diabetic agents. We typically use pioglitazone in a dose of 15 mg/day. We avoid using pioglitazone with insulin. We do not use pioglitazone under following situations: In the presence of significant or proven cardiac disease, in patients who are struggling with their weight or need to lose weight, in patients at high risk for osteoporotic fractures, in patients with macular edema, in patients with pre-existing bladder cancer and would discontinue in case hematuria or any other symptom of bladder cancer develops. We continue to use the drug in patients well controlled on it without any evident side-effects or contraindications.
吡格列酮作为一种胰岛素增敏剂可改善血糖控制，用于2型糖尿病的治疗。最近，吡格列酮的安全性问题引发了争议。对于该药物在糖尿病治疗中的使用方式、时间和剂量，目前尚无明确的共识。我们总结了在大型私立三级医疗中心——梅丹塔 Medicity 中使用吡格列酮治疗2型糖尿病的策略，这可能有助于进一步思考这种抗糖尿病药物的定位。我们将吡格列酮列为口服抗糖尿病药物中的第四线用药。我们通常以每日15毫克的剂量使用吡格列酮。我们避免将吡格列酮与胰岛素联用。在以下情况下我们不使用吡格列酮：存在严重或已确诊的心脏疾病、体重难以控制或需要减重的患者、骨质疏松性骨折高危患者、黄斑水肿患者、已患有膀胱癌的患者，若出现血尿或任何其他膀胱癌症状则停药。对于使用该药物病情得到良好控制且无明显副作用或禁忌证的患者，我们继续使用该药物。
