Glitazones

Glitazones (or thiazolidinediones) are the only class of medication for Type 2 diabetes that addresses the root cause of the disorder: insulin resistance. Actos (pioglitazone) and Avandia (rosiglitazone) are the two diabetic medications of this type currently available in the US. Both work by increasing the sensitivity of insulin receptors in the liver, muscle and fat.

In studies, these two medications have been shown to both increase insulin sensitivity and lower excess production of glucose by the liver. In Type 2 diabetes, insulin resistance causes the body to react by increasing insulin output, so patients on glitazones also see a reduction in insulin levels. Additionally, glitazones appear to increase the size of LDL (low-density lipoprotein) molecules, which may make the LDL less dangerous. HDL (or “good” cholesterol) is increased, while blood pressure and triglyceride levels are generally reduced.

In addition to all these benefits, part of the way in which Glitazones increase insulin sensitivity is by reducing levels of alpha tumor necrosis factor, which is implicated as a cause of heart disease. Overall, these medications seem to not only address insulin resistance in type 2 diabetes, but also improve blood cholesterol, lipid and glucose levels. Greatest impact on blood glucose levels is generally seen after meals, but glitazones by themselves will not cause hypoglycemia. (When used in conjuction with a sulfonylurea or insulin, excessively low blood glucose is still possible.)

Glitazones will not affect those with type 1 diabetes, or what is known as “type 1.5″ diabetes, where insulin production is lower than normal. Actos and Avandia are only effective when insulin resistance is present. Common signs of insulin-resistant diabetes are excess abdominal weight, low HDL levels in the bloodstream, high triglyceride levels or high blood pressure. However, for individuals with insulin resistance, glitazones may be able to prevent or delay eventual failure of the diabetic’s beta cells, by reducing the need for excess insulin production.



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