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Where thiazolidinediones will fit
Author(s) -
Reasner Charles A.
Publication year - 2002
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.250
Subject(s) - medicine , insulin resistance , type 2 diabetes , glycemic , insulin , macrovascular disease , diabetes mellitus , microalbuminuria , combination therapy , diabetic retinopathy , rosiglitazone , disease , endocrinology
Individuals with type 2 diabetes have two defects: insulin resistance, which occurs in the first stages of disease progression, and pancreatic β‐cell failure, which occurs later in the disease. Insulin resistance is the major pathological defect. During the course of the disease, insulin levels are initially elevated to compensate for the increased insulin resistance and then decline as the disease progresses and β‐cells become less responsive. It is necessary to change antidiabetic therapies to address this progression. Current management of type 2 diabetes follows a stepwise treatment program of diet and exercise, monotherapy with oral antidiabetic agents, combination oral therapy and, ultimately, combination therapy with insulin to control blood glucose levels. While control of blood glucose will reduce the risk of microvascular complications, such as microalbuminuria and retinopathy, the incidence of macrovascular complications is not significantly reduced. The introduction of the thiazolidinediones (TZDs) or ‘glitazones’, a class of agents that offer effective glycemic control and work through the reduction of insulin resistance, offers a new strategy in the management of this condition. These agents have beneficial effects on the pancreatic β‐cell and, in addition, may have potential benefits on the macrovascular complications that commonly occur in these patients. Copyright © 2002 John Wiley & Sons, Ltd.