Diabetes Q&A

Are Thiazolidinediones Safe for Patients With Diabetes and Renal Disease?

Treatment with thiazolidinediones may result in better glucose control and serum lipid in patients with diabetes mellitus and renal impairment. However, thiazolidinedione treatment may lead to a greater risk of weight gain and edema in these patients, researchers reported.

Thiazolidinediones, which are mostly metabolized by the liver, offer an additional treatment option for diabetes patients with end-stage renal failure. Some previous research has suggested that thiazolidinediones could have renal benefits such as decreased urinary albumin and protein excretion, but there has been controversy regarding cardiovascular safety.

_________________________________________________________________________________________________________________________________
RELATED CONTENT
Diabetes Influences Outcomes in Chronic Heart Failure
How Obesity, Type 2 Diabetes Affect the Brain
_________________________________________________________________________________________________________________________________

To better understand the benefits and risks of thiazolidinediones, researchers conducted a systematic review and meta-analysis that included randomized controlled trials, cohort studies, and case-control studies. The studies focused on the effects of thiazolidinediones in patients with diabetes and renal impairment. Nineteen randomized controlled trials and 3 cohort studies were analyzed, with a total of 21,803 patients included.

Results from meta-analysis of randomized controlled trials indicated that thiazolidinediones could significantly reduce HbA1c [mean difference (MD), −0.64; 95% confidence interval (CI), −0.93 to −0.35) and fasting plasma glucose (MD, −26.27; 95% CI, −44.90 to −7.64], as well as increase HDL levels (MD, 3.70; 95% CI, 1.10, 6.29).

However, results also suggest that thiazolidinediones could increase weight (MD, 3.23; 95% CI, 2.29 to 4.16) and edema risk [relative risk (RR), 2.96; 95% CI, 1.22 to 7.20]. The analysis showed uncertain effects on risk of hypoglycemia (RR, 1.46; 95% CI, 0.65 to 3.29), heart failure (RR, 0.64; 95% CI, 0.15 to 2.66), angina (RR, 1.45; 95% CI, 0.23 to 8.95), and all-cause mortality (RR, 0.40; 95% CI, 0.08 to 2.01). Cohort studies had results that resembled those of randomized controlled trials.

The uncertain effects of thiazolidinediones on cardiovascular events and all-cause mortality were mostly a result of small sample sizes, the researchers noted.

“More carefully designed, conducted, adequately powered studies (both randomized controlled trials and observational studies) are warranted to examine the effect on the long-term patient important outcomes,” the study’s authors concluded.

—Lauren LeBano

Reference

Wang W, Zhou X, Kwong JSW, Li L, Li Y, Sun X. Efficacy and safety of thiazolidinediones in diabetes patients with renal impairment: a systematic review and meta-analysis. Scientific Reports. 2017;1717. doi:10.1038/s41598-017-01965-0.