A Retrospective Medication Use Evaluation of Pioglitazone in Patients with Type 2 Diabetes Mellitus in a County Health Care System

Abstract

Background

Pioglitazone is a thiazolidinedione oral second-line antihyperglycemic agent in the treatment of type 2 diabetes but was the highest expenditure within restricted drugs in this county health care system. Objective: A medication use evaluation of pioglitazone was conducted to determine if usage was according to guideline as well as evaluate intermediate clinical outcomes.

Methods

This is a retrospective analysis of a convenience sample of 199 patients who were prescribed pioglitazone therapy over a 6-month period. The following data were collected: demographics, indication, dosing, concurrent diabetes medications, pre- and post-glycosylated hemoglobin (HbA_1c), fasting blood glucose (FBG), liver function tests, lipid profiles, and adverse drug events. Data were analyzed by descriptive statistics, t-test, and chi-square test.

Results

The final analysis included 199 patients of which 194 (97%) had documented prespecified guideline criterion for pioglitazone use. The average patient's age was 55 (standard deviation [SD] 9.5), and 72 (36.2%) of the patients were male. Ninety-nine percent of the patients were on dual therapy. After an average follow-up period of 10.5 weeks, the HbA1c decreased from a mean of 9.8% (SD 1.8%) to 8.7% (SD 1.7%) (P < 0.05) and FBG decreased from a mean of 212 mg/dL (SD 72 mg/dL) to 174 mg/dL (SD 74 mg/dL) (P < 0.05). In a subanalysis of 98 patients with pre- and post-lipid panels, the high-density lipoprotein (HDL) increased (P < 0.001) and triglycerides decreased (P < 0.02).

Conclusion

Pioglitazone usage in this county health care system meets preset criteria 97.5% of the time and contributes to improved glycemic control. As to whether the impact on surrogate markers led to decreases in morbidity and mortality needs to be researched in larger prospective studies in the county population.