In the current literature there are different opinions about the use of
thiazolidinediones or sulfonylureas. Some authors have reported that
thiazolidinediones increase total body
glucose disposal and reduce hepatic
glucose production, reducing both peripheral and hepatic
insulin resistance (or enhances both peripheral and
insulin sensitivity). They consider
thiazolidinediones a better drug compared to sulfonylureas because they do not induce
hypoglycemia and they provide a protection for the pancreatic beta-cell. On the other side, some authors have reported that the improved
glycemic control obtained with
thiazolidinedione use is associated with an increase in
body weight and a worsening of
lipid profile, and they also warn providers to consider the potential for serious adverse cardiovascular effects of the treatment with
rosiglitazone for
type 2 diabetes mellitus, negating some of the benefits of the improved metabolic control. They have also reported that sulfonylureas are safer compared to
thiazolidinediones because they give a better and faster improvement of
glycated hemoglobin without giving the adverse effects reported with the use of
thiazolidinediones. Considering the emerging discrepancies from these studies we decided to undertake a thorough literature search on Medline and Embase to evaluate the effects of
thiazolidinediones and sulfonylureas in people with diabetes. In particular, this review examines the effects and the rationale and practicalities for the use of sulfonylureas or
thiazolidinediones, alone and in combination
therapy with other antidiabetes drugs, to treat
type 2 diabetes mellitus considering, as primary end points,
glycated hemoglobin, fasting plasma
glucose, fasting plasma
insulin, homeostasis model assessment indices,
body weight, body mass index, blood pressure, and, when available, data on
lipid profile. We also evaluated the effects of these two drugs on beta-cell function,
insulin resistance, and inflammatory markers, also recording the frequency of adverse events such as
edema and
heart failure.