Editor—The liver function tests before starting treatment with pioglitazone gave normal results apart from a bilirubin measurement of 20 and an alanine aminotransferase concentration of 44. His glycated haemoglobin concentration was 8.6, and there was no evidence of a previous reaction to gliclazide.
I agree that monitoring of liver function tests is mandatory but, in this case, liver disease was not found before treatment was started.
As Amin says, given the histopathology report, a more robust test of liver function may have uncovered unsuspected disease. In addition, perhaps the first liver function test check after starting treatment should be sooner than the two months recommended by the National Institute for Clinical Excellence.
Competing interests: None declared.