How effective are thiazolidinediones (TZDs) in the treatment of type 2 diabetes mellitus (DM)?

Updated: Jul 13, 2021
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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In the Canadian Normoglycemia Outcome and Evaluation (CANOE) trial, glycemic parameters and insulin sensitivity improved in patients taking rosiglitazone and metformin in year 1 but deteriorated in the years thereafter, as in the placebo arm. Beta-cell function remained relatively stable in both groups for the first 2 years but then deteriorated progressively in subsequent years. The investigators attributed the lower rate of incident diabetes in the rosiglitazone/metformin group to the early effect of treatment. [188]

In a study by DeFronzo et al, pioglitazone was found to reduce the progression to frank diabetes by 72% in patients with IGT. [189] However, the drug was associated with significant edema and weight gain.

In the Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication (DREAM) trial, rosiglitazone reduced the incidence of diabetes by 62%. It also improved the achievement of normoglycemia by 70% in patients with IFG and by 64% in patients with both IFG and IGT. [190]

A study by Phung et al investigated oral agents used for prevention of type 2 diabetes and found that TZDs resulted in a greater risk reduction than biguanides. Sulfonylureas and glinides had no benefit. [191]

TZDs generally decrease triglyceride levels and increase HDL cholesterol levels. They increase LDL cholesterol, but this increase may involve large, buoyant LDL, which may be less atherogenic.

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