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Thiazolidinediones (TZDs)

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Stroke Revisited: Diabetes in Stroke

Part of the book series: Stroke Revisited ((STROREV))

Abstract

Insulin resistance is essential pathophysiology of type 2 diabetes mellitus (T2DM). And unsuppressed lipolysis in adipocytes with increased free fatty acids (FFAs) concentration and deposit in various tissues contribute to develop insulin resistance. Thiazolidinediones (TZDs) were developed by chance to explore potent fibrate hypolipidemic drugs since mid-1970s. The mechanism by which TZDs reduce insulin resistance involves binding to the peroxisome proliferator-activated receptor (PPAR) γ, a transcription factor that regulates the expression of specific genes, especially in adipose tissue. The most significant advantage of TZDs (pioglitazone, lobeglitazone, and rosiglitazone) is that they do not cause hypoglycemia as monotherapy and are not contraindicated in patients with renal disease. By terms of efficacy, TZDs effectively reduce glycated hemoglobin A1c as a mono- or combination therapy and showed beneficial effects on lipid profiles (molecular specific). And TZDs are well known to be effective in the prevention of diabetes in subjects with high risk and to maintain the durability of insulin sensitivity. However, fluid retention, edema, and the risk of aggravating heart failure are the major adverse effects of TZD. And unresolved critical issues are remained Cardiovascular safety, association with certain cancers (i.e., bladder cancer), macular edema, and osteoporosis in women. Therefore, clinical judgments are needed in the use of TZDs with a balance of their strengths and weakness.

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Authors and Affiliations

  1. Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea

    Jong Chul Won

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Correspondence to Jong Chul Won .

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  1. Department of Neurology, Seoul National University Hospital, Seoul, Korea (Republic of)

    Seung-Hoon Lee

  2. Korean Cerebrovascular Research Institute, Seoul, Korea (Republic of)

    Dong-Wan Kang

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Won, J.C. (2021). Thiazolidinediones (TZDs). In: Lee, SH., Kang, DW. (eds) Stroke Revisited: Diabetes in Stroke. Stroke Revisited. Springer, Singapore. https://doi.org/10.1007/978-981-16-5123-6_11

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  • DOI: https://doi.org/10.1007/978-981-16-5123-6_11

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