Impact of rosiglitazone therapy on the lipid profile, glycemic control, and medication costs among type 2 diabetes patients

Thiazolidinedione drugs in the treatment of type 2 diabetes mellitus: past, present and future

Thiazolidinedione (TZD) drugs used in the treatment of type 2 diabetes mellitus (T2DM) have proven effective in improving insulin sensitivity, hyperglycemia, and lipid metabolism. Though well tolerated by some patients, their mechanism of action as ligands of peroxisome proliferator-activated receptors (PPARs) results in the activation of several pathways in addition to those responsible for glycemic control and lipid homeostasis. These pathways, which include those related to inflammation, bone formation, and cell proliferation, may lead to adverse health outcomes. As treatment with TZDs has been associated with adverse hepatic, cardiovascular, osteological, and carcinogenic events in some studies, the role of TZDs in the treatment of T2DM continues to be debated. At the same time, new therapeutic roles for TZDs are being investigated, with new forms and isoforms currently in the pre-clinical phase for use in the prevention and treatment of some cancers, inflammatory diseases, and other conditions. The aims of this review are to provide an overview of the mechanism(s) of action of TZDs, a review of their safety for use in the treatment of T2DM, and a perspective on their current and future therapeutic roles.

Lipid effects and cardiovascular disease risk associated with glucose-lowering medications

Diabetes is a global epidemic, associated with a high burden of complications and 4.6 million deaths annually worldwide. As a result of decreasing levels of physical activity and increasing rates of obesity, diabetes is shifting from a disease affecting the elderly to one that affects younger patients or even children. Thus, aggressive treatment and optimal control of risk factors is the key to improve outcomes in those patients. Accumulating evidence of the cardiovascular and lipid effects of glucose-lowering medications suggest that treatment efficacy in diabetes can be further improved. This review provides an overview of the lipid effects and cardiovascular disease risk of current anti-diabetic medications and highlights opportunities and challenges in clinical practice.