Metformin useful in overwt., insulin resistant people with nl renal function.  Suppresses appetite, assists with weight control.

Use of Metformin diabetic patients with heart failurehas recently been reported to be associated with lower morbidity and mortality compared to sulfonylurea drugs

Glimeparide better than other sulfonylurea drugs in patients with MI

TZD’s are selective PPAR gamma selective - Improve insulin sensitivity but also improve FFA metabooism and markers of inflammation (Cardio CRP) and lipids.  Do cause adipocyte proliferation and lipid storage in adipocytes, ie, weight gain.

Pioglitazone has more alpha agonist effect than does rosiglitazone and therefore has more favorable effect on lipids (Incr. HDL, Decr. Trigl and VLDL)

TZD’s also protective in early glucose intolerance from development of diabetes.

Two Glitazars now in phase III trials.  These are dual PPARs-

Muraglitazar - more effective in lowering Hg A1c and triglycerides than pioglitazone.

Tesaglitazar - similar to muraglitazar but associated with more weight gain.