Summarising the use of thiazolidinediones with insulin

Both insulin resistance and pancreatic beta-cell function normally contribute to the development of type 2 diabetes, with the latter also responsible for the progression of the disease. Successful management inevitably requires therapy that addresses both underlying defects. Clinical trials support the use of agents with complementary mechanisms of action. The major therapeutic effect of the thiazolidinediones in type 2 diabetes is improvement of insulin sensitivity and they are thus ideally suited for combination therapy with insulin, although they can also be used as monotherapy or in dual or triple oral agent therapy. In addition to improving glycaemic control, the thiazolidinediones have favourable effects on a number of cardiovascular risk factors and may reduce the risk of long-term diabetes-related complications independent of their effects on glycaemic control. Combination therapy of a thiazolidinedione with insulin is no longer contraindicated in Europe, and this combination can provide improvements in glycaemic control that are additive to the effects of insulin alone.