Beneficial effects resulting from thiazolidinediones for treatment of type 2 diabetes mellitus.

Because new drugs continue to be developed, physicians treating patients with type 2 diabetes have a wide range of agents from which to choose. The newest class, the thiazolidinediones (TZDs), should be a mainstay of treatment for most patients with type 2 diabetes, because these agents reduce insulin resistance as well as improve glycemic control. Patients with the insulin resistance syndrome are at increased risk for developing cardiovascular disease. However, decreasing insulin resistance with TZD use may reduce the incidence of adverse cardiovascular outcomes. TZDs also may reduce cardiovascular events by acting directly on vascular smooth muscle cells and by helping patients maintain normal hemoglobin levels, without the risk of hypoglycemia. Furthermore, prolonged glycemic control is expected with TZDs because of their effects on beta-cell rejuvenation, a function unique to this class. TZDs can be used safely in renally impaired patients with diabetes, and hepatotoxicity has not been a problem with second-generation TZDs, making these agents both safe and effective in the treatment of type 2 diabetes.