Role of thiazolidinediones in the management of type 2 diabetes: focus on ethnic minority populations.

Persons from ethnic minority populations in the United States suffer disproportionately more from type 2 diabetes and its complications than do Caucasians. Genetic and acquired factors likely contribute to the ethnic disparities of type 2 diabetes. The pathophysiologic hallmarks consist of insulin resistance, progressive pancreatic beta-cell dysfunction, and excessive hepatic glucose production. The ideal treatment for type 2 diabetes should correct insulin resistance and beta-cell dysfunction; and normalize hepatic glucose output; and prevent, delay, or reverse diabetic complications. The discovery of a new class of drugs, thiazolidinediones, has provided an effective tool to correct key underlying defects in type 2 diabetes. Thiazolidinediones improve insulin sensitivity and have beneficial effects on pancreatic beta-cell function and hepatic glucose production. Furthermore, their potent insulin-sensitization effect predicts that treatment with thiazolidinediones will improve cardiovascular risk factors, including lipid profile, fibrinolysis, endothelial function, and atheroinflammatory markers. These benefits are expected to be particularly important among ethnic minority patients who tend to have greater insulin resistance than do Caucasians.