Thiazolidinediones with high glucose-lowering efficacy reduce secondary CV endpoints; ADA and EASD's consensus

USA: Thiazolidinediones are oral medications having high glucose-lowering efficacy and durability of glycemic effect, according to a recent consensus update by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). 

The report by ADA and EASD on hyperglycemia management was presented at the 58th EASD Annual Meeting in Stockholm, Sweden, and subsequently published in the journals Diabetologia and Diabetes Care.

The document mentioned that in the PROspective pioglitAzone Clinical Trial In macroVascular Events (PROactive) in patients with type 2 diabetes and macrovascular disease, there was a reduction in the secondary cardiovascular endpoints, although a significant primary outcome was not achieved. Lower risk of stroke or myocardial infarction was seen with pioglitazone vs placebo in the Insulin Resistance Intervention After Stroke (IRIS) study in patients without diabetes but with insulin resistance (HOMA-IR >3.0) and recent history of stroke or transient ischaemic attack. 

The article further mentions the beneficial effects of pioglitazone on non-alcoholic steatohepatitis (NASH) and non-alcoholic fatty liver disease (NAFLD) which, the article states, "should be balanced against possible side effects of weight gain and bone fracture, congestive heart failure (HF) and fluid retention. Using low doses and combining it with other medications (SGLT2 inhibitors and GLP-1 receptor agonists) which promote sodium excretion and weight loss could mitigate its side effects. 

According to the report, thiazolidinediones are generally not recommended in renal impairment due to the potential for fluid retention. 

About Thiazolidinediones

Thiazolidinediones, also called glitazones, are medications used for the treatment and management of type 2 diabetes mellitus. The medications may act as an insulin sensitizer and a nuclear transcription regulator. 

Thiazolidinediones' use in managing type 2 diabetes can help with insulin resistance and glycemic control. Two thiazolidinediones namely pioglitazone and rosiglitazone are currently approved by the FDA as monotherapy or combined with sulfonylureas it metformin for managing the condition. 

Thiazolidinediones (TZDs) are insulin sensitizers that exhibit their mechanism of action through intracellular metabolic pathways to increase insulin sensitivity and enhance insulin action in critical tissues.