Type 2 diabetes mellitus (T2DM) is characterized by a progressive beta cell dysfunction
in the setting of peripheral insulin resistance. Insulin resistance in subjects with type 2 diabetes and
metabolic syndrome is primarily caused by an ectopic fat accumulation in the liver and skeletal
muscle. Insulin sensitizers are particularly important in the management of T2DM. Though thiazolidinediones
(TZDs) are principally insulin sensitizers, they possess an ability to preserve pancreatic
β-cell function and thereby exhibit durable glycemic control. Cardiovascular outcome trials
(CVOTs) have shown that Glucagon-like-peptide 1 receptor agonists (GLP-1 RAs) and sodium glucose
transporter-2 inhibitors (SGLT2i) have proven cardiovascular safety. In this era of CVOTs,
drugs with proven cardiovascular (CV) safety are often preferred in patients with preexisting cardiovascular
disease or at risk of cardiovascular disease. In this review, we will describe the three
available drugs belonging to the TZD family, with special emphasis on their efficacy and CV safety.
Keywords: Pioglitazone, rosiglitazone, glycemic control, heart failure, cardiovascular disease, insulin resistance.
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