Management of DiabetesINTRODUCTION

According to the American Diabetes Association, more than 18 million people in the U.S. have diabetes. In the past 20 years, a number of advances in the management and treatment of diabetes have taken place. In contrast to earlier days, when insulin was the only available treatment, new classes of oral agents have been developed and introduced to the market over the years. These agents include the sulfonylureas (first-generation and second-generation), biguanides, alpha-glucosidase inhibitors, meglitinides, and thiazolidinediones (TZDs). The TZDs are of special interest because their mechanism of action involves a reduction in insulin resistance and because they improve some of the cardiovascular risk factors usually present in patients with type-2 (non-insulin-dependent, “adult-onset”) diabetes mellitus.

This review discusses the information needed to perform a comprehensive and systematic evaluation of two TZDs, canadian rosiglitazone (GlaxoSmithKline) and pioglitazone (Actos canadian, Takeda). Both agents are indicated either as monotherapy or in combination with a sulfonylurea,  or insulin when diet, exercise, and a single agent do not result in adequate glycemic control. Both agents may improve cardiovascular parameters, such as lipid levels, blood pressure, inflammatory biomarkers, endothelial function, and fibrinolytic status. However, evidence is lacking regarding clinical outcomes such as vascular disease and mortality.

This article follows the structure of the Format for Formulary Submissions, as recommended by the Academy of Managed Care Pharmacy, to facilitate the formulary-selection process.