[Glitazones (thiazolidinedione)].
Insulin resistance is the major defect in type 2 diabetes. Troglitazone is the first of a new class of drugs, the thiazolidinediones (TZD) with insulin sensitising actions. The TZD activate PPAR gamma (Peroxisome Proliferator Activated Receptor gamma). In clinical trials, the TZD decrease plasma glucose, plasma insulin and Hb A1C. Moreover they are synergistic with the glucose lowering drugs (biguanides and sulfonylureas) and with insulin therapy. The TZD also decrease triglycerides and increase HDL cholesterol, while reducing LDL oxidation. Few side effects have been reported but concerns persist about their safety. Hepatic dysfunction is seen in about 2% of the patients receiving troglitazone, leading sometimes to liver failure. This potentially lethal side effect appears to be less frequent with the second generation TZD, rosiglitazone and pioglitazone. Drug interactions, fluid retention, induction of colon polyps are other potential unwanted effects. This new class of drugs could play an important role in diabetes therapy, if clinical trials prove their long term efficacy and safety.
Ducobu
J
J
Service de Médecine Interne, C.H.U. Tivoli, La Louvière.
Sternon
J
J
D000818:Animals; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005943:Gluconeogenesis / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use / Q000633:toxicity; D007333:Insulin Resistance; D051381:Rats; D018160:Receptors, Cytoplasmic and Nuclear / Q000819:agonists; D013844:Thiazoles / Q000494:pharmacology / Q000627:therapeutic use / Q000633:toxicity; D045162:Thiazolidinediones; D014157:Transcription Factors / Q000819:agonists
D007004:Hypoglycemic Agents; D018160:Receptors, Cytoplasmic and Nuclear; D013844:Thiazoles; D045162:Thiazolidinediones; D014157:Transcription Factors; C089946:2,4-thiazolidinedione