What Are Glitazones?

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What are glitazones?

Glitazones or thiazolidinediones are a class of oral diabetes medication. They help your natural insulin work more effectively by reducing your body’s insulin resistance.

How do glitazones work?

Glitazones are medications for type 2 diabetes. People with type 2 diabetes are resistant to the effects of insulin. Glitazones work by reducing your body’s insulin resistance and helping insulin work more effectively to control blood glucose levels. Glitazones also have other beneficial effects, including lowering blood pressure and improving your blood balance of good to bad fats.

An example of a glitazone is pioglitazone or Actos, the only member of the group of medications that are currently licenced for use in the UK.

How to take glitazones

You should take Actos once daily, as prescribed. You can take it with or without food, but you should try and take it at the same time every day. Swallow the tablets whole with a little liquid to wash them down.

You may be prescribed pioglitazone alone or in combination with metformin, a sulphonylurea, or both. You can also use pioglitazone in combination with insulin therapy.

If you forget to take your tablet, take your next dose at your usual time. Don’t take a double dose to compensate. If you take too much pioglitazone, particularly with other diabetes medication, you are at risk of hypo.

Contact your doctor if you have taken too much of your glitazone. If you have symptoms of low blood sugar, eat fast-acting carbohydrates like jelly babies, dextrose tablets, cola or fruit juice. These act quickly to raise your blood glucose, but you should also eat starchy carbohydrates, like bread or biscuits, for a more sustained increase in sugar levels until your next meal.

Advantages of glitazones

The benefits of Actos include:

Improved insulin sensitivity in tissues in muscles and the liver
Reduced blood glucose when fasting and after a meal
Reduction in blood pressure. Taking a glitazone regularly can improve your diabetes control, lower your HbA1c and protect against long term diabetes complications
Improvements in the balance of healthy to unhealthy cholesterol in your blood

Glitazones side effects

The only glitazone that is licenced for use in the UK is pioglitazone or Actos. The glitazone medication Rosiglitazone was associated with an increased risk of heart attack and stroke. In a review, the risks of treatment were assessed to be more significant than the benefits. As a result, Rosiglitazone was banned for use in the UK in 2010.

Members of the glitazone group of drugs have different risks and side effects.

The side effects and complications of pioglitazone include:

Weight gain
Insomnia
Water retention
Numbness
Increased risk of infections
Allergies and skin rashes
Worsening of osteoporosis and bone fractures
Uncommonly pioglitazone may cause oedema and heart failure
Rarely pioglitazone may cause liver problems, macular oedema, anaemia and increase the risk of bladder cancer

The risks of pioglitazone have come under scrutiny. NICE has said:

‘pioglitazone is associated with an increased risk of heart failure, bladder cancer and bone fracture. Known risk factors for these conditions, including advanced age, should be carefully evaluated before treatment.’

Pioglitazone and bladder cancer risk

Research has linked pioglitazone with the risk of developing bladder cancer. A comprehensive European Medical Agency review into the potential link found a small increased risk. However, the agency’s Committee for Medicinal Products for Human Use assessed that the benefits of treatment outweigh the risks in people with no risk factors for bladder cancer. It isn’t clear whether the increased risk develops after prolonged exposure or early in treatment remains unclear. Appropriate patient selection can reduce the small increased risk.

Healthcare professionals shouldn’t prescribe pioglitazone in patients with:

Active bladder cancer
History of bladder cancer
Blood in the urine that has not been thoroughly investigated
The pros and cons of treatment should be carefully assessed in people with other bladder cancer risk factors such as increasing age, pelvic radiotherapy in the past, smoking and exposure to occupational or chemotherapy agents that are linked to bladder cancer, such as cyclophosphamide

If your doctor prescribes pioglitazone, they should review your health and the effects of the treatment after three to six months. If you haven’t responded to treatment as shown by better diabetes control and a reduced HbA1c, they should change to an alternative diabetes medication.

If you want to find out more about effective diabetes medications, speak to one of our specialists at the London Diabetes Centre about prospective treatment options today.

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Sources:

https://www.gov.uk/drug-safety-update/pioglitazone-risk-of-bladder-cancer

https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/tablets-and-medication/thiazolidinediones-glitazones

https://cks.nice.org.uk/topics/diabetes-type-2/prescribing-information/pioglitazone/

https://care.diabetesjournals.org/content/36/Supplement_2/S155

https://www.nhs.uk/medicines/pioglitazone/

https://www.nice.org.uk/guidance/ng28