Thiazolidinedione use in elderly patients with type 2 diabetes: With and without heart failure

Purpose: To compare the prescribing patterns of thiazolidinediones (TZDs) in elderly patients with type 2 diabetes with and without heart failure (HF). Methods: The national health insurance claims database from the Health Insurance Review & Assessment Service (HIRA), Korea was used. Elderly patients with type 2 diabetes taking at least one hypoglycemic agent were studied between July 1, 2005 and June 30, 2006. Patients were grouped according to the presence of HF. The proportion of patients receiving TZDs were compared between the two groups, and stratified by their diabetes medication regimen (monotherapy and combination therapy). The difference in the patterns of TZD prescribed was studied across all health care levels including: primary, secondary, and tertiary care facilities. Results: Among 357855 elderly patients with type 2 diabetes, 24746 patients had HF. TZDs were prescribed to 10.4% of the patients with HF and 8.8% of the patients without HF (p<0.01). In the combination therapy group, the proportion of patients receiving TZDs was 17.9% and 14.4% in patients with and without HF, respectively (p<0.01). In the primary care setting, the proportion of TZD prescriptions in patients with HF was 5.6% and it was 4.6% in patients without HF (p<0.01). Conclusions: TZDs were frequently prescribed to patients with HF, even though the TZDs were contraindicated in patients with HF. Health care professionals should consider alternative therapies for patients with type 2 diabetes mellitus. In addition, they should carefully monitor the impact of TZD use in patients with HF.