Pathogenic management strategies for type 2 diabetes. New requirements and new potentialities
Insulin resistance (IR) is one of the key mechanisms underlying the development and progression of type 2 diabetes (T2D). IR can be diagnosed in prediabetes and even in the lack of the existing disorders of carbohydrate metabolism. This paper highlights the properties of a drug that improves tissue sensitivity to insulin, pioglitazone. This medication provides good glycemic control and reduces the risk of cardiovascular events. In patients with prediabetes and IR, pioglitazone slows the progression of carbohydrate metabolism disorders to T2D and also provides cardioprotective effect. In T2D, this agent could be of great interest in terms of intensifying the therapy as a part of complex treatment, in particular, when combined with dipeptidylpeptidase-4 inhibitors or sodium-glucose cotransporter 2 inhibitors. Current priorities of the rational choice of antidiabetic therapy for T2D require personalized management, targeting pathogenic mechanisms, and the correction of risk factors and comorbidities. Considering this, multiple effects of pioglitazone can be of crucial importance when deciding on patient selection.