Antidiabetic drugs present and future: Will improving insulin resistance benefit cardiovascular risk in type 2 diabetes mellitus?

Results from the United Kingdom Prospective Diabetes Study showed that inte nsive treatment of type 2 (non-insulin-dependent) diabetes mellitus, with s ulphonylureas or insulin, significantly reduced microvascular complications but did not have a significant effect on macrovascular complications after 10 years. Insulin resistance plays a key role in type 2 diabetes mellitus and is linked to a cluster of cardiovascular risk factors. Optimal treatmen t for type 2 diabetes mellitus should aim to improve insulin resistance and the associated cardiovascular risk factors in addition to achieving glycae mic control. Treatment with sulphonylureas or exogenous insulin improves gl ycaemic control by increasing insulin supplies rather than reducing insulin resistance. Metformin and the recently introduced thiazolidinediones have beneficial effects on reducing insulin resistance as well as providing glyc aemic control. There is evidence that, like metformin, thiazolidinediones a lso improve cardiovascular risk factors such as dyslipidaemia and fibrinoly sis. Whether these differences will translate into clinical benefit remains to be seen. The thiazolidinediones rosiglitazone and pioglitazone have bee n available in the US since 1999 (with pioglitazone also being available in Japan). Both products are now available to physicians in Europe.