The forgotten type 2 diabetes mellitus medicine: rosiglitazone.

Type 2 diabetes mellitus (T2DM) is a chronic disease prevalent in the world, and it is also one of the overall factors leading to overall morbidity and mortality. Throughout Asia, the proportion of people with T2DM and obesity has increased and this growth rate shows no signs of slowing down. Thiazolidinediones (TZDs) can specifically treat insulin resistance and improve metabolic syndrome, including rosiglitazone, troglitazone and pioglitazone, which are peroxisome proliferator-activated receptor (PPAR) agonists. These drugs have been shown to have better therapeutic effect and glycemic control, but also accompanied by a series of adverse reactions. Cardiovascular events are currently the most serious adverse events of rosiglitazone, which cardiovascular toxicity is higher than pioglitazone. Rosiglitazone has been restricted or even withdrawal from the market in most countries owing to concerns about its cardiovascular safety, while its beneficial effect on insulin resistance has been demonstrated. New data on rosiglitazone-mediated heart failure, myocardial infarction and fractures provide clinicians with prescriptions with fewer side effects to treat patients. Studies have shown that rosiglitazone is the most effective treatment in TZDs (in vivo study), not only hypoglycemic effect but with some additional effects, such as anti-inflammatory and anti-cancer capabilities, retinopathy (animal models) and ischemia-reperfusion injury protection effects, lipid regulation and blood pressure reduction, etc. Although rosiglitazone shows the highest risk of arrhythmia in diabetes management while has the capacity to reduce the risk of atrial fibrillation. © The Japan Diabetes Society 2021.