Campbell I W
Victoria Hospital, Kirkcaldy, Fife, Scotland.
Int J Clin Pract. 2004 Feb;58(2):192-200. doi: 10.1111/j.1368-5031.2004.0108.x.
Patients with type 2 diabetes have dual defects: insulin resistance and beta-cell dysfunction. Thiazolidinediones (TZDs), a new class of oral drugs used for the treatment of type 2 diabetes, reduce insulin resistance via an action on peroxisome proliferator-activated receptors. There is also growing evidence that TZDs may preserve beta-cell function. Pioglitazone is a TZD that provides appropriate monotherapy or combination treatment for patients with type 2 diabetes. Studies of up to 32-week duration have shown that pioglitazone significantly reduces HbA1c and fasting plasma glucose when used alone or in combination with another glucose-lowering agent. Four recently published 52-week clinical trials, involving over 3700 patients with type 2 diabetes, show that pioglitazone is an effective long-term treatment, both as monotherapy and in combination with metformin or sulphonylurea. As well as maintaining glycaemic control over the long term, pioglitazone also confers benefits in terms of improvements in fasting insulin, lipid parameters, C-peptide and 32,33-split proinsulin (independent predictors of cardiovascular risk) and hypoglycaemia compared with other monotherapies or combination therapies. It is well tolerated, with a low incidence of adverse events. These long-term data support the concept that pioglitazone should be used earlier in the treatment of type 2 diabetes, either as monotherapy or as add-on therapy.
2型糖尿病患者存在双重缺陷：胰岛素抵抗和β细胞功能障碍。噻唑烷二酮类药物（TZDs）是一类用于治疗2型糖尿病的新型口服药物，通过作用于过氧化物酶体增殖物激活受体来降低胰岛素抵抗。越来越多的证据表明，TZDs可能会保留β细胞功能。吡格列酮是一种TZDs，可为2型糖尿病患者提供适当的单一疗法或联合治疗。长达32周的研究表明，吡格列酮单独使用或与另一种降糖药物联合使用时，可显著降低糖化血红蛋白（HbA1c）和空腹血糖。最近发表的四项为期52周的临床试验，涉及3700多名2型糖尿病患者，表明吡格列酮无论是作为单一疗法还是与二甲双胍或磺脲类药物联合使用，都是一种有效的长期治疗方法。除了长期维持血糖控制外，与其他单一疗法或联合疗法相比，吡格列酮在改善空腹胰岛素、血脂参数、C肽和32,33-裂解胰岛素原（心血管风险的独立预测指标）以及低血糖方面也有好处。它耐受性良好，不良事件发生率低。这些长期数据支持了吡格列酮应在2型糖尿病治疗中更早使用的观点，无论是作为单一疗法还是作为附加疗法。
