[Is a new therapeutic class justified in the treatment of type 2 diabetes?].
Type 2 diabetes is responsible for various micro and macro-vascular complications, appearing early in the course of the disease. The UKPDS results clearly demonstrate the interest of an early and intensive treatment of hyperglycaemia to reduce theses microvascular complications and, to a lesser extent, macrovascular complications. The UKPDS also demonstrate the limits of the current management of type 2 diabetes: delayed diagnosis when several complications already exist, difficulties to maintain an adequate glucose control over the time, particularly with monotherapy, need for an intensive combination treatment policy, unwanted effects of this intensive treatment (weight gain, hypoglycaemias). The 3 classes of oral antidiabetic agents currently available (sulfonylureas and meteglinide analogues, metformin, a-glucosidase inhibitors) imperfectly cover the current therapeutic needs. Thus, the new class, the thiazolidinediones, acting on key physiopathological components, appears as a welcome addition to the treatment of type 2 diabetes. The association of metformin (or a sulfonylurea) and a thiazolidinedione should permit to obtain early a better glycaemic control without the hypoglycaemic risk associated with intensive therapy at an early stage of type 2 diabetes.
Halimi
S
S
Service d'Endocrinologie - Diabétologie - Nutrition, CHU de Grenoble, F - 38043 Grenoble Cedex, France.
D000284:Administration, Oral; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008687:Metformin / Q000008:administration & dosage / Q000627:therapeutic use; D013844:Thiazoles / Q000737:chemistry / Q000627:therapeutic use*; D045162:Thiazolidinediones
D007004:Hypoglycemic Agents; D013844:Thiazoles; D045162:Thiazolidinediones; D008687:Metformin; C089946:2,4-thiazolidinedione