The clinical effectiveness and cost effectiveness of rosiglitazone for type 2 diabetes mellitus

Abstract

AIM OF THE REVIEW The aim of the review was to evaluate the clinical effectiveness and cost effectiveness of rosiglitazone in the treatment of patients with Type 2 diabetes mellitus. BACKGROUND Type 2 diabetes is a chronic metabolic disorder that results from defects in insulin secretion and insulin action. The resulting build up of glucose in the blood can cause a range of diabetic complications, including microvascular and macrovascular damage to various organs as small blood vessels or large arteries become narrow or blocked. People with diabetes are at particularly high risk of cardiovascular disease. This appears to be related directly to hyperglycaemia, but also to hypertension and adverse lipid profiles. Evidence from the United Kingdom Prospective Diabetes Study (UKPDS) has shown that maintaining good control of blood glucose reduces the incidence of diabetic complications. It is thought that the prevalence of Type 2 diabetes is around 800,000 for England and Wales. Guidelines recommend a “step-up” policy of treatment for Type 2 diabetes, starting with diet and lifestyle advice, adding oral glucose-lowering agents (principally metformin and the sulphonylureas) and ultimately insulin if targets are not achieved. Type 2 diabetes tends to be progressive and the effectiveness of treatment falls over time. Rosiglitazone is one of a new class of oral glucose-lowering drugs, the PPAR-gamma agonists, which have a different mode of action to existing medications.