Thiazolidinediones

Zhao

Cardiovascular Therapeutics

et al. 2015

SUMMARY Introduction:The relationship between the beneficial effects of pioglitazone in reducing clinical events and plaque inflammatory burden remains unknown. This study aimed to determine whether pioglitazone can reduce the number of plaque thrombosis incidences and whether decreasing plaque inflammation is the mechanism by which pioglitazone reduces plaque thromboses. Methods and Results: therosclerotic rabbits were divided into two groups: the atherosclerosis group (n = 13) and pioglitazone group (n = 10). The rabbits underwent pharmacological triggering to induce thrombosis. Serum inflammatory markers, FDG uptake, macrophage, and neovessel staining detected arterial inflammation. PET/CT scans were performed twice (baseline and posttreatment scans). Plaque area, macrophages, and neovessels were measured and the histologic sections were matched with the PET/CT scans. Serum MMP-9 and hsCRP were lower in the pioglitazone group compared to the atherosclerosis group. The SUVmean significantly decreased in the pioglitazone group (0.62 AE 0.21 vs. 0.55 AE 0.19, P = 0.008), but increased in the atherosclerosis group (0.61 AE 0.15 vs. 0.91 AE 0.20, P < 0.000). The incidence rate of plaque rupture, plaque area, macrophage density, and neovessel density was significantly lower in rabbits with pioglitazone than without (15% vs. 38%, P < 0.001; 18.00 AE 2.30 vs. 27.00 AE 1.60; P < 0.001; 8.80 AE 3.94 vs. 28.26 AE 2.49; P < 0.001; 16.50 AE 3.09 vs. 29.00 AE 2.11; P < 0.001, respectively). Moreover, plaque area and macrophage density were positively correlated with SUV values. Conclusions: Our study suggests that pioglitazone can reduce the number of plaque thrombosis incidences by decreasing plaque inflammation.

Section: Discussionsupporting

confidence: 80%

Plaque Thrombosis is Reduced by Attenuating Plaque Inflammation with Pioglitazone and is Evaluated by Fluorodeoxyglucose Positron Emission Tomography

Zhao

Cardiovascular Therapeutics

et al. 2015

“…12 Troglitazone was the first agent in this category to be approved by the FDA. 13 As troglitazone use increased, idiosyncratic hepatic failure began to be reported. By March 2000, the FDA had received reports of 63 hepatic failure cases resulting in death in patients treated with troglitazone, and shortly thereafter, the drug was removed from the market.…”

Section: Sulfonylureasmentioning

confidence: 99%

A Brief History of the Development of Diabetes Medications

White¹

2014

Diabetes Spectrum

147

118

Internal Medicine Journal

“…There is also evidence to suggest that these agents may preserve b-cell function. 19 This could be of great importance as there is a typically progressive decline in b-cell function in type 2 diabetes leading to worsening glycaemic control and the need for increasing therapy over time. They work alone, in combination with other oral hypoglycaemic agents and with insulin to improve diabetic control in type 2 diabetes.…”

Section: Management Guidelinesmentioning

confidence: 99%

“…These agents should be used cautiously in persons with mild cardiac failure and are not recommended for use in more advanced cardiac failure (New York Heart Association classes 3 and 4). 19,20 The thiazolidinediones may also have benefits in the reduction of cardiovascular risk factors. They have been shown to decrease blood pressure, improve diabetic dyslipidaemia, improve endothelial function and reduce markers of increased thrombotic risk.…”

Section: Management Guidelinesmentioning

confidence: 99%

Diabetes: advances in treatment

Cohen

Shaw

2007

The increasing prevalence of diabetes worldwide is cause for concern both in terms of associated morbidity and increasing health costs. This review aims to focus on new and emerging treatments for type 1 and type 2 diabetes. There has been recent focus on diabetes prevention both for type 1 and type 2 diabetes. Prevention programme including lifestyle measures and oral hypoglycaemic agents have shown up to 61% reduction in the development of type 2 diabetes in patients with impaired glucose tolerance or impaired fasting glucose. Little progress has been made to date on type 1 diabetes prevention although current work is focusing on T-cell immunomodulation therapy and beta cell regeneration. Management of type 2 diabetes has been improved by the recent introduction of the peroxisome proliferator-activated receptor-gamma agonists and more recently by the incretins including glucagons like peptide analogues and dipeptidyl peptidase-4 inhibitors. This article focuses on the benefits and restrictions of these new agents. The new insulin analogues glargine and detemir have made significant improvements in the management of type 1 diabetes both in terms of improvement in glycaemic control and in reducing hypoglycaemia rates. Inhaled insulin also shows promise for needle-free treatment of diabetes and these insulins are currently undergoing phase 3 trials. Insulin infusion pumps are becoming more sophisticated and increasingly popular in the management of type 1 diabetes. Many studies have shown benefits for improved glycaemic control and reduced rates of hypoglycaemia with pump treatment compared with multiple daily injections. Pancreas and islet cell transplantation are the subject of ongoing research, but currently require immunosuppressive treatment regimes. The main limitation is lack of availability of donor pancreases. There is much hope that new treatments outlined in this review will result in improved outcomes in the treatment of diabetes.