M. Fuchtenbusch et al., Clinical efficacy of new thiazolidinediones and glinides in the treatment of type 2 diabetes mellitus, EXP CL E D, 108(3), 2000, pp. 151-163
Citations number
50
Categorie Soggetti
Endocrinology, Nutrition & Metabolism
Journal title
EXPERIMENTAL AND CLINICAL ENDOCRINOLOGY & DIABETES
A central finding of the UKPDS was that in type 2 diabetic patients, tight
glycemic control with HbA1c targets as close to the normal range as possibl
e must be achieved to further reduce diabetes related-complications, -morta
lity, and -cardiovascular disease, highlighting the need for new, optimized
treatment strategies. With a focus on clinical efficacy, this paper discus
ses the results from the 20 major therapeutical trials published in the yea
rs 1997-1999, that evaluated the new insulinsensitizing thiazolidine, dione
s Rosiglitazone and Pioglitazone and the new insulin-releasing potassium ch
annel blockers Repaglinide and Nateglinide. While for Nateglinide, promisin
g, but only preliminary data is available at current, Rosiglitazone, Piogli
tazone, and Repaglinide have been shown appropriate for both mono- and comb
ination therapy with current standard drug treatment of type 2 diabetes. Si
milar to the known, older antidiabetic drugs, the new agents discussed have
comparable blood glucose lowering potentials with a dose-related capacity
of 0.5 to 1.5% HbA1c reduction. These beneficial effects were both seen in
drug-naive patients previously treated with diet only and in combination th
erapies when patients had previous antidiabetic standard drug treatment sug
gesting effectiveness of glitazones and glinides also in more advanced stag
es of the disease. Problems with adverse effects appeared minor although lo
nge-range implications of weight gain, edema, lowering of hemoglobin, incre
ase of total cholesterol for the glitazones, and hypoglycemia for glinides
warrant further consideration. What becomes clear from the variety of most
recent mono- and combination treatment studies with as much as five differe
nt classes of antidiabetic drugs is that individually tailored therapies th
at recognize quality of life parameters and target the predominant features
of metabolic pathology (such as early postprandial versus lasting hypergly
cemia, degree of insulin resistance, progressive loss of beta-cell function
) may become a feasible goal in the future.