Keeping Up With Safety Warnings of Oral Antidiabetic Drugs

Abstract

Timothy Nguyen, PharmD, BCPS Oral antidiabetic drugs are no doubt major components in the management for patients with type 2 diabetes. Nurse practitioners (NPs), without exception, are frontline in the management of patients with diabetes. With so many new oral antidiabetic drugs available for diabetes management, new safety warnings on potential side effects associated with these agents also emerge. Oftentimes, it is difficult for practitioners to sort out and stay abreast with the new safety information in their busy practices. In this issue of the journal, a few important and unique safety profiles of the newer oral antidiabetic drug classes will be highlighted to help NPs sort out the safety information associated with their use. NPs are very familiar with older oral antidiabetic drugs such as alpha-glucosidase inhibitors, biguanides, sulfonylureas, meglitinide, and others; however, the relatively newer classes of oral antidiabetic drugs including thiazolidinediones, dipeptidyl peptidase-4 inhibitors (also known as “gliptins” or incretin enhancers), and sodium-glucose cotransporter 2 inhibitors have had more recent warnings released. Warnings issued from the Food and Drug Administration (FDA) regarding diabetes drugs involve cardiovascular-related risks. For those drugs that belong to the thiazolidinedione class (pioglitazone and rosiglitazone), in 2007 the FDA communicated a possible association between rosiglitazone and increased cardiovascular risk. According to the RECORD trial, those with type 2 diabetes who took either rosiglitazone plus other oral antidiabetic drugs were compared with those who took metformin and sulfonylureas. In the secondary composite end point, those in the rosiglitazone group showed an increase in heart failure. In light of cardiovascular warnings and in general, practitioners should probably avoid using this group of oral antidiabetic drugs in people with heart failure. A few years later,