Management of Type 2 Diabetes With Thiazolidinediones

The clinical onset of type 2 diabetes in most patients is typically preceded by years of insulin resistance. Type 2 diabetes develops when pancreatic β cells are unable to produce sufficient insulin to overcome the insulin resistance. Several recent trials have shown that the thiazolidinediones (TZDs) improve both insulin sensitivity and pancreatic β-cell function. A likely mechanism for the protective effect of TZDs is improvement in lipotoxicity. The most compelling reason to use a TZD at the earliest stage of type 2 diabetes is the unique ability of these agents to rejuvenate or decelerate the decline in pancreatic β-cell function. This article reviews both the pathophysiology of decreased β-cell function and the evidence for rejuvenation of pancreatic β cells with TZD therapy in both animal and human studies.