What are the benefits of the TZDs mechanism of action on insulin resistance compared with other therapies?
The TZDs are true insulin sensitizers-ie, their ability to enhance the action of insulin in the body is central to their clinical action. None of the other modalities used to treat diabetes are as effective at reducing insulin resistance as the TZDs. Metformin is sometimes considered to act as a “sensitizer,” but it has not shown that ability in all studies. Metformin reduces the production of glucose by the liver and effectively reduces insulin levels secondary to the reduction in plasma glucose; thus, it is more correctly referred to as an insulin-“sparing” drug. The clinical effects of metformin on some of the risk variables associated with the insulin-resistant state are in the same direction as that caused by the TZDs; however, they are generally less robust, including anti-inflammatory effects, reduction in free fatty acid (FFA) levels, and reduction in high-sensitivity C-reactive protein (hs-CRP). The other oral medications for Type 2 diabetes-and even insulin insulin itself–ha
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