Via practica 9/2008

GLITAZONES – PAST, PRESENT AND FUTURE

Type 2 diabetes mellitus is a progressive and complex disorder that is difficult to treat effectively in the long term. The majority of patients will be unable to achieve or sustain near normoglycaemia without oral antidiabetic agents; a sizeable proportion of patients will eventually require insulin therapy to maintain long-term glycaemic control. The frequent need for escalating therapy is held to reflect progressive loss of islet beta-cell function, usually in the presence of insulin resistance. The average glucose-lowering effect of the major classes of oral antidiabetic agents is broadly similar (averaging 0,8 – 1,5 % reduction in HbA1c). The insulin resistence is related with dyslipidemia, endotelial dysfunction, obesity and atherosclerosis. The insulin-sensitising thiazolidinedione (glitazone) new class of antidiabetic agents has potentially advantageous effects on multiple components of the metabolic syndrome. Published data are suggesting that thiazolidinediones may provide better long-term glycaemic stability. Tailoring the treatment to the individual patient is an important principle.

Keywords: diabetes management, thizolidindione, glitazone, troglitazone, roziglitazone, pioglitazone, clinical trials.