Insulin-sensitizing agents--thiazolidinediones (glitazones).

Insulin resistance is a fundamental feature of type 2 diabetes and is also associated with increased cardiovascular risk. The thiazolidinediones are insulin sensitizing agents which improve insulin resistance by combining with an intranuclear hormone receptor. They have been shown in human studies to both reduce insulin resistance and improve pancreatic beta-cell function. They are effective both as monotherapy and in combination with sulphonylureas or metformin in improving glycaemia, with evidence of improvement in other features of metabolic syndrome. They are generally well tolerated, do not cause hypoglycaemia and have the potential to provide sustained diabetic control and reduce cardiovascular risk. They appear to be an important advance in diabetes management but further work is still required to determine their true potential.