[Mechanisms and clinical effects of pioglatizone as a new agent for the treatment of type-2 diabetes].

Thiazolidinediones (TDZs, glitazones) form a new substance group in the treatment of diabetes mellitus. As a result of influences on insulin signalling, glucose transport, hepatic glucose metabolism and modulation of the peroxisome proliferator activating receptor (PPAR-gamma), TZDs augment the effect of insulin in insulin-sensitive target tissues. Pioglitazone (CAS 111025-46-8 resp. 112529-15-4; Actos) is a member of the group of glitazones. According to existing clinical data, pioglitazone at a once daily oral dose of 15 to 45 mg, as monotherapy or in combination with sulphonylureas, metformin or exogenous insulin, has a pronounced and reproducible blood sugar-lowering effect. As well as improving glucose metabolism, pioglitazone has a beneficial effect on insulin resistance and the plasma levels of free fatty acids, triglycerides and HDL-cholesterol which is clinically relevant. Pioglitazone is well tolerated: treatment of 4300 type 2 diabetics worldwide has not revealed any evidence of hepatotoxic potential. Owing to their pathophysiological mode of action, glitazones have the potential to reduce the incidence of long-term diabetic complications in addition to their blood sugar-reducing effect.