Management of Type 2 Diabetes With Thiazolidinediones Link Between beta-Cell Preservation and Durability of Response

摘要

The clinical onset of type 2 diabetes in most patients is typically preceded by years of insulin resistance. Type 2 diabetes develops when pancreatic beta cells are unable to produce sufficient insulin to overcome the insulin resistance. Several recent trials have shown that the thiazolidinediones (TZDs) improve both insulin sensitivity and pancreatic beta-cell function. A likely mechanism for the protective effect of TZDs is improvement in lipotoxicity. The most compelling reason to use a TZD at the earliest stage of type 2 diabetes is the unique ability of these agents to rejuvenate or decelerate the decline in pancreatic /3-cell function. This article reviews both the pathophysiology of decreased beta-cell function and the evidence for rejuvenation of pancreatic beta cells with TZD therapy in both animal and human studies.