[Type 2 diabetes mellitus: Which place for thiazolidinediones in the therapeutic strategy?].
Several new pharmacological agents have recently been developed to optimise the management of type 2 diabetes mellitus. The aim of this article is to briefly review the new therapeutic class: thiazolidinediones (TZD), acting as these insulin sensitizer and to suggest a logical use of these drugs in the guidelines proposed by the french recommendations for the treatment of type 2 diabetic subjects. These agents are now introduced in Europe, only in combination with metformin or sulfonylureas (or glinides). Moreover, some preliminary data indicate that these agents could delay the decrease of insulin secretion by the beta pancreatic cells and could reduce other cardiovascular risk factors often associated with type 2 diabetes: hypertension and lipid abnormalities, by reducing blood pressure, triglycerides and increasing HDL cholesterol. These new drugs bring some hope in the treatment of type 2 diabetic patients in combination with the previous oral anti-diabetic drugs which have recently demonstrated (UKPDS) their ability to prevent or to reduce complications due to diabetes. However the frequency of adverse events must be evaluated in a large use, beyond phase II and III, after the withdrawal of the first TZD introduced on the market (troglitazone).
Halimi
S
S
Service Endocrinologie, Diabètologie, Nutrition CHU de Grenoble, Grenoble, France. shalimi@ujf-grenoble.fr
D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005060:Europe; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D008687:Metformin / Q000008:administration & dosage / Q000627:therapeutic use; D013453:Sulfonylurea Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D013844:Thiazoles / Q000008:administration & dosage / Q000627:therapeutic use*
D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D013844:Thiazoles; D008687:Metformin