The new clinical trials with thiazolidinediones--DREAM, ADOPT, and CHICAGO: promises fulfilled?
OBJECTIVE
Despite extensive documentation of their insulin-sensitizing and antihyperglycemic effects, the importance and place of the thiazolidinediones in diabetes management remain unclear. Three new controlled clinical trials of thiazolidinediones offer new information on the clinical utility of these agents.


RESULTS
During the past year, three new trials of thiazolidinediones were reported. In Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication, rosiglitazone reduced progression to diabetes in prediabetic patients by 60%. A Diabetes Outcome Progression Trial found rosiglitazone to have greater antihyperglycemic durability than metformin and glyburide in patients with recently diagnosed type 2 diabetes. Finally, in the Carotid Intima-media Thickness in Atherosclerosis using Pioglitazone, treatment with pioglitazone in patients with type 2 diabetes slowed progression of carotid wall thickness compared with the sulfonylurea glimepiride.


CONCLUSIONS
These trials support the contention that thiazolidinediones have superior efficacy in improving and stabilizing glycemic control than older antihyperglycemic agents, especially early in the course of type 2 diabetes. Findings from the Carotid Intima-media Thickness in Atherosclerosis using Pioglitazone add to the evidence that these agents have clinically meaningful vasculoprotective effects. Although generally well tolerated, they promote weight gain, limiting their acceptability to some extent, and occasionally lead to a diagnosis of heart failure, mostly in susceptible individuals.
Goldberg
Ronald B
RB
Division of Endocrinology, Diabetes and Metabolism, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, Florida 33136, USA. rgoldber@med.miami.edu
D000328:Adult; D000368:Aged; D002339:Carotid Arteries / Q000473:pathology; D002986:Clinical Trials as Topic; D003920:Diabetes Mellitus / Q000188:drug therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007328:Insulin / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D017257:Ramipril / Q000627:therapeutic use; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000494:pharmacology* / Q000627:therapeutic use
D007328:Insulin; D045162:Thiazolidinediones; D000077154:Rosiglitazone; D017257:Ramipril