La diabetes tipo 2 es una enfermedad heterogénea en la que se asocia la resistencia a la insulina y el déficit relativo y posteriormente absoluto de insulina.
Recientemente se han descrito una serie de fármacos capaces de disminuir la glicemia posprandial de los pacientes diabéticos así como disminuir las concentraciones de HbA1c y mejorar el control metabólico. La repaglinida y la nateglinida actúan aumentando la secreción de insulina.
Entre las tiazolidenedionas se han utilizado la toglitazona, la rosiglitazona y la pioglitazona. Su mecanismo de accion es estimulando los receptores de la PPAR-γ y activando la entrada de glucosa.
La experiencia sobre estos fármacos es limitada. Parece que la pioglitazona y la rosiglitazona tienen menos efectos secundarios que los descritos para la toglitazona (hepatotoxicidad).
Dichos fármacos pueden utilizarse en combinación con la insulina o con la metformina.
Type 2 diabetes is an heterogeneous disease in which development contributes insulin resistance and insulin sensitivity.
In order to reduce post-prandial hyperglycemia in these patients, a group of new drugs have been considered as a therapeutic tool for decreasing HbA1c and reaching a better metabolic control. Repaglinide and Nateglinide have been used to increase insulin secretion.
Other new drugs such as Toglitazone, Rosiglitazone and Pioglitazone have been described recently. Their mechanism of action is stimulating the PPAR-γ receptors which produces an activation of glucose uptake. These drugs can be used with Metformin which mainly acts by inhibiting the hepatic glucose production.
In spite of that, there is limited experience with these drugs. It seems that Pioglitazone and Rosiglitazone have considerably fewer side effects as described for Toglitazone (Hepatotoxicity). Thus, these drugs can be used in combination with insulin or another insulin sensitizer as Metformin.