Role of insulin secretagogues and insulin sensitizing agents in the prevention of cardiovascular disease in patients who have diabetes.
In the absence of clinical trial evidence to compare the secretagogues with sensitizers, it is difficult to make recommendations about which class of drug is more important to prescribe for the prevention of cardiovascular disease in diabetes mellitus. Epidemiologic data supports insulin resistance as a major factor in cardiovascular disease through a variety of mechanisms. Because sensitizers improve insulin sensitivity and correct many of the vascular abnormalities that are associated with insulin resistance, it is tempting to suggest that they may be superior for this purpose. Conversely, meeting the goals that are recommended for glycemia also are important and achieving them may not be always possible with sensitizers, particularly in the later stages of the disease when insulin levels are not high,despite insulin resistance. In such situations,combination therapy may be needed with both types of drugs. No data are available on the cardiovascular effects of such combinations;some retrospective data suggest a possibility of increased events with the combination of sulfonylureas and metformin. Thus, further prospective studies in this area are necessary.
Jawa
Ali A
AA
Department of Medicine, Section of Endocrinology, Tulane University Medical Center, SL-53, 1430 Tulane Avenue, New Orleans, LA 70112-2699, USA.
Fonseca
Vivian A
VA
D015906:Angioplasty, Balloon, Coronary; D000818:Animals; D001645:Biguanides / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002839:Chromans / Q000494:pharmacology; D003925:Diabetic Angiopathies / Q000503:physiopathology / Q000517:prevention & control*; D004730:Endothelium, Vascular / Q000502:physiology; D005342:Fibrinolysis / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008687:Metformin / Q000627:therapeutic use*; D018384:Oxidative Stress / Q000502:physiology; D019518:Postprandial Period / Q000502:physiology; D012307:Risk Factors; D000077154:Rosiglitazone; D013453:Sulfonylurea Compounds / Q000627:therapeutic use*; D045162:Thiazolidinediones / Q000494:pharmacology / Q000627:therapeutic use; D000077288:Troglitazone
D001645:Biguanides; D002839:Chromans; D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; D000077154:Rosiglitazone; D008687:Metformin; D000077288:Troglitazone