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Conception as a Potential Consequence of Diabetes Treatment

The first 20% of the full text of this article appears below.

	PRESENTATION

 
M.M. is a 45-year-old white woman with a medical history of type 2 diabetes, polycystic ovarian syndrome (PCOS), hypertension, and gastroesophageal reflux disease. She had a history of one normal, healthy pregnancy and delivery without complication. The patient was diagnosed with diabetes in 1994, and after 2000 developed painful diabetic neuropathy and microalbuminuria.

At 42 years of age, she was being followed by both her primary care physician (PCP) and collaboratively by a clinical pharmacist within the same academic practice. At that time, she was prescribed 30 mg pioglitazone daily, 1,000 mg metformin twice daily, 10 mg glipizide twice daily, 2.5 mg enalapril daily, 25 mg hydrochlorothiazide daily, and 81 mg aspirin daily. For neuropathic pain, she was receiving 5 mg methadone three times daily, 300 mg gabapentin three times daily, and 40 mg fluoxetine daily. She had been receiving metformin since 2001, and pioglitazone since 2003.

At the time of pioglitazone initiation, she was counseled regarding the possible effects of the medication on increasing fertility in women with PCOS. She said she did not want to become pregnant, but she refused hormonal contraceptives or an intrauterine device. Both she and her husband were counseled to use barrier contraception methods.

By February 2004, her pioglitazone had been titrated to 30 mg once daily. Her weight was 233 lb and height 64 inches, for a BMI of 40 kg/m². Her most recent hemoglobin A_1c (A1C) was 6.2%, and her serum chemistries were within normal limits.

Her PCP noted that she was recently nonadherent with both glipizide and metformin because of her concern about low blood glucose. . . . [Full Text of this Article]

	QUESTIONS

 

	COMMENTARY

 

	CLINICAL PEARLS

 

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