Drug and Therapeutics Bulletin 2008;46:25-29; doi:10.1136/dtb.2008.03.0008
Copyright © 2008 by the BMJ Publishing Group Ltd.

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Glitazones in type 2 diabetes: an update

Relevant BNF section: BNF 6.1.2.3

The glitazones and their combination products are licensed for type 2 diabetes mellitus and now account for over 50% of NHS expenditure on oral hypoglycaemic drugs.¹ In 2001, for pioglitazone and rosiglitazone (the two glitazones licensed in the UK), we concluded that evidence (from short-term studies) supported their use in combination with metformin or a sulphonylurea in patients unsuited to one or other of these drugs, but not more practical glitazone use, such as monotherapy or as part of triple therapy.² We also said that their long-term effects were not yet clear.² Since then, both drugs have also been licensed for monotherapy, as part of triple therapy that includes metformin and a sulphonylurea and, for pioglitazone, use with insulin.^3,4 Here we reassess glitazones in light of published efficacy data and safety concerns raised in recent years.