Department of Endocrinology, Southside Endocrinology, Irondale, Alabama, USA.
Department of Endocrinology, Lipscomb University, Nashville, Tennessee, USA.
Diabetes Obes Metab. 2023 Nov;25(11):3093-3102. doi: 10.1111/dom.15222. Epub 2023 Aug 3.
Pioglitazone improves glycaemic control, not only by lowering insulin resistance, but also by improving beta cell function. Because of the improved beta cell function the glycaemic control that occurs with pioglitazone is prolonged. Pioglitazone has positive effects not only on cardiac risk factors and surrogate measures of cardiovascular disease, it also lowers the incidence of cardiac events in patients with diabetes. The recurrence of transient ischaemic attack and ischaemic stroke is also reduced in non-diabetic, insulin-resistant subjects. Utilized at preclinical stages (but not later) of heart failure, pioglitazone improves diastolic function and avoids progression to heart failure. Pioglitazone, through suppression of atrial remodelling, also decreases the incidence of atrial fibrillation. The manifestations of diseases associated with insulin resistance (non-alcoholic steatohepatitis and polycystic ovary disease) are also improved with pioglitazone. Pioglitazone may possibly improve psoriasis and other dermopathies. Pioglitazone is therefore an inexpensive and efficacious drug for the insulin-resistant subject with diabetes that is underutilized because of biases that have evolved from the toxicities of other thiazolidinediones.
吡格列酮不仅通过降低胰岛素抵抗来改善血糖控制，还通过改善β细胞功能来实现。由于β细胞功能的改善，吡格列酮所实现的血糖控制更为持久。吡格列酮不仅对心血管疾病的危险因素和替代指标有积极影响，还降低了糖尿病患者的心脏事件发生率。在非糖尿病、胰岛素抵抗的患者中，短暂性脑缺血发作和缺血性中风的复发也减少了。在心力衰竭的临床前阶段（而非后期）使用吡格列酮，可改善舒张功能并避免进展为心力衰竭。吡格列酮通过抑制心房重构，还降低了心房颤动的发生率。与胰岛素抵抗相关的疾病（非酒精性脂肪性肝炎和多囊卵巢病）的表现也因吡格列酮的改善而得到改善。吡格列酮可能改善银屑病和其他皮肤疾病。因此，吡格列酮是一种廉价且有效的药物，适用于因其他噻唑烷二酮类药物的毒性而产生偏见而未被充分利用的糖尿病胰岛素抵抗患者。
