OBJECTIVE To evaluate the efficacy of metformin against placebo, diet, oral anti-diabetics, or insulin in type 2 diabetes mellitus. DESIGN Systematic review. DATA SOURCES MEDLINE (1966-2003), EMBASE (1974-2003), LILACS (1986-2003), Cochrane library (Issue 3, 2003). SELECTION OF STUDIES 29 randomized clinical trials of metformin in monotherapy, with results on mortality, morbidity, and bio...

The prevalence of metabolic syndrome, obesity and insulin resistance has become an epidemic in the world. A strong association exists between metabolic syndrome and non-alcoholic fatty liver disease (NAFLD), though the etiology of NAFLD is still unclear. This close association leads to numerous clinical studies to investigate the effects of insulin sensitizers, thiazolidinediones (TZDs), on hep...

The invention of thiazolidinediones, also referred to as glitazones, has been one of the greatest developments in the treatment of Type II diabetes over the last two decades. Although the efficacy of the glitazones is substantial, their use has been limited by adverse effects including edema, weight gain and cardiac issues. While still being used for a specific subset of diabetic patients, much...

The thiazolidinediones are a unique class of oral antidiabetic agents that has been shown to directly reduce insulin resistance at sites of insulin action, specifically adipose tissue, skeletal muscle, and the liver. By reducing insulin resistance, these drugs influence many of the modifiable cardiovascular risk factors associated with the insulin resistance syndrome, also known as the cardiova...

Polycystic ovary syndrome (PCOS) is the most frequent cause of female infertility. The treatment of PCOS patients with insulin sensitizers, such as metformin or thiazolidinediones, increases the ovulation rate and the number of successful pregnancies. The positive action of the insulin-sensitizing treatments could be explained by a decrease in the peripheral insulin resistance but also by a dir...

Potent ligands of peroxisome proliferator-activated receptor γ (PPARγ) such as thiazolidinediones (pioglitazone, troglitazone, etc.) improve insulin sensitivity by increasing the levels of adiponectin, an important adipocytokine associated with insulin sensitivity in adipose tissue. Several constituents from medicinal plants were recently reported to show PPARγ agonist-like activity in 3T3-L1 c...