Treatment Options to Control Blood Glucose

3. Treatment Option B: Oral Antidiabetes Medication

Thiazolidinedione (pioglitazone or rosiglitazone)

Thiazolidinedione (TZD) therapy is most effective when used as an adjunct to a treatment regimen that includes diet and exercise in combination with another class of oral agent such as metformin or a sulfonylurea. It has been clearly demonstrated that combination treatment increases efficacy.⁴ The disadvantage of this option is that TZDs have an onset of action of about 2 to 3 weeks, with maximal action in 4 to 5 months.

Comment: Diabetes mellitus is a progressive disease characterized by a decline in ß-cell function and insulin resistance.⁷ Unexplained weight loss and high blood glucose levels appear to be important predictors of ß-cell dysfunction. Hyperglycemia and glucose toxicity further compromise the ability of the ß cell to release insulin.⁸ If the symptoms of hyperglycemia are to be controlled, Mrs. S requires a faster decrease in PG than she would obtain with initiation of a TZD, even in combination with another OAD.

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