Clinical use

The thiazolidinediones are approved for use as monotherapy or in combination with secretagogues, metformin, or insulin therapy. Unlike most antidiabetic medications, which have a rapid onset of activity, pioglitazone and rosiglitazone require 8-12 weeks or more to achieve maximal clinical benefit. This is probably related to their mode of action, i.e., the regulation of gene expression. To date, there have been no head-to-head studies comparing rosiglitazone and pioglitazone, and no studies on patient characteristics that may predict a good treatment response with these agents.

When used as monotherapy or adjunctive therapy, thiazolidinediones typically decrease HbA1C by 1-1.5%.70 Clinical studies with rosiglitazone monotherapy lowered FPG by up to 55mgdL_ 1. Similarly, pioglitazone (15, 30, and 45 mg doses) reduced FPG (by 30, 32, and 56mgdL_ 1, respectively) and HbA1C (by 0.3, 0.3, and 0.9%, respectively).71 Dividing the daily dose (twice daily) was more effective in reducing both FPG levels and HbA1C levels compared with single daily dosing.72

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