Abstract

Will PPAR-y agonist therapy still have a role in diabetes management in 2013?

Author(s): George Grunberger

Thiazolidinediones have been used for treatment of Type 2 diabetes since the late 1990s. They act as ligands for PPAR‑g, activating hundreds of genes in many tissues. Their actions result in favorable (insulin-sensitizing) and unfavorable (fluid retention, weight gain and decrease in bone mass) effects. This article describes the dilemma encountered by clinicians contemplating the use of these agents to improve diabetes control in the current environment, which is currently focused on ‘protecting’ the patient from the putative harm ascribed to rosiglitazone (ischemic myocardial events) and pioglitazone (bladder cancer) rather than the benefits of these therapies.