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Class Iv : Type 2 Diabetes

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CLASS IV: THIAZOLIDINEDIONES
Type 2 diabetes is mainly associated with abnormalities in any of the following 3 basic pathophysiologic abnormalities:
• Impaired insulin secretion
• Excessive hepatic glucose production
• Insulin resistance in skeletal muscle, liver and adipose tissue.9
The thiazolidinediones are a unique class of agents that improve the third parameter, and are therefore also called as the “Insulin sensitizers”. Insulin resistance syndrome also called as Syndrome X is caused by a variety of pathophysiologic abnormalities mainly obesity, glucose intolerance or type II diabetes, dyslipidemia, hypertension and accelerated cardiovascular disease. All of these are basically associated with insulin resistance and compensatory …show more content…

The TZDs seem to also have advantages of prevention of cardiovascular complications of the metabolic syndrome. They have effects on the following aspects of the metabolic syndrome:
• Lowering blood pressure
• Decreasing lipid abnormalities(diabetic dyslipidemia)
• Reducing inflammatory mediators(like C reactive protein, matrix metalloproteinase -9, leukocyte counts)
• Improving pro-coagulant properties such as abnormal coagulation and fibrinolysis.10

Mechanism of action: The thiazolidinediones selectively form a ligand with the nuclear transcription factor, peroxisome proliferator –activated receptor gamma subtype (PPAR) and thus play a role in insulin resistance. Due to this unique action on insulin resistance, the TZDs can have a role in also treating non diabetic patients with insulin resistance issues.

The PPAR receptor is expressed predominantly in the liver, heart, muscle and the vascular wall. The PPAR gamma subtype receptor is expressed most abundantly in adipose tissue, pancreatic beta cells, vascular endothelium and macrophages and is mainly targeted by the TZDs.

According to clinical studies, the TZDs mainly lower fasting and postprandial glucose concentrations as well as free fatty acid concentrations. Most studies also indicated that there is a decrease in insulin concentrations. The fact that the TZDs act as insulin sensitizers has been confirmed by direct measurements in in vivo studies in humans.12

Treatment of non- diabetic

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