Thiazolidinediones: the Forgotten Diabetes Medications - PubMed (original) (raw)

Review

Thiazolidinediones: the Forgotten Diabetes Medications

Harold E Lebovitz. Curr Diab Rep. 2019.

Abstract

Purpose of review: Thiazolidinediones (TZDs) are the only pharmacologic agents that specifically treat insulin resistance. The beneficial effects of TZDs on the cardiovascular risk factors associated with insulin resistance have been well documented. TZD use has been limited because of concern about safety issues and side effects.

Recent findings: Recent studies indicate that cardiovascular toxicity with rosiglitazone and increase in bladder cancer with pioglitazone are no longer significant issues. There are new data which show that pioglitazone treatment reduces myocardial infarctions and ischemic strokes. New data concerning TZD-mediated edema, congestive heart failure, and bone fractures improves the clinician's ability to select patients that will have minimal significant side effects. Thiazolidinediones are now generic and less costly than pharmaceutical company-promoted therapies. Better understanding of the side effects coupled with clear benefits on the components of the insulin resistance syndrome should promote TZD use in treating patients with type 2 diabetes.

Keywords: Bone fractures; CV outcomes; Heart failure; Insulin resistance; PPARγ agonists; Type 2 diabetes.

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Conflict of interest statement

Harold E. Lebovitz declares that he has no conflict of interest.

Figures

Fig. 1

Fig. 1

Insulin-resistant type 2 diabetes is the co-existence of two separate metabolic abnormalities: a primary beta-cell disease: diabetes mellitus and a lipid distribution abnormality which creates insulin resistance, the metabolic syndrome, and increased cardiovascular disease. These abnormalities can be separate or co-exist. These abnormalities can interact in susceptible populations leading to an increase in the prevalence of diabetes and an increase in atherosclerotic disease

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