Квантовая физика и медицина - разноуровневые подходы к биологическим объектам (Вы ничего не слышали про теорию струн и адроны?)

Сегодня по утру обнаружил в своей почте очередное сообщение о прионах.
Решил освежить свои знания о них, пошел по подвернувшимся ссылкам и неожиданно оказался на интернет-порталах, посвященных квантовой механике. И, так как физика - моя первая, еще "домедицинская" любовь (3 года учебы в ЗФТШ при МФТИ с 8-го по 10-й классы с.ш.) - стало интересно протестировать степень собственного невежества в этой сфере.
Про адроны мы еще кое-что слышали, предположим. Про Большой Адронный Коллайдер, например. А вот про теорию струн и ее роль для понимания микромира - лично мне было ничего не известно. А ведь она радикально меняет наши представления о мире в целом. И это - всего лишь одна из множества подобных мировоззренческих концепций относительно мироустройства.

Известно, что общей "теорией всего" занимался Эйнштейн. Полагаю, он был не первым. И не последним, это точно. Известно также, что "теория всего" никогда не будет разработана, так как этого самого "всего" просто не существует. И прежде всех это осознали сами физики - мир не просто дуален - он бесконечноален. "Простая" платоновско-гегелевская диалектика рассматривает мир в полярном. двойном противоречии - "минус" и "плюс". Ан нет, существует неэвклидова геометрия и квантовая физика (и далеко не только они), доказывающие, что кроме плюсов и минусов существуют соседствующие полярности ("минус-в-плюсе", "минус-сбоку-плюса, "подмножество плюсов в минусе", цепочки "минус-плюс-минус-плюс"...)

Надо будет освежить свои знания по квантовой механике... продолжение следует...

Пациенты часто не знают, какие препараты им назначают в стационаре

Краткое резюме  интересной статьи на злободневную тему в дайджетсе Physician's First Watch.

С одной строны, доктора не считают необходимым сообщать пациентам, чем они их лечат в больнице, и какие препараты они рекомендуют принимать пациетам после выписки (мол, все будет указано в выписном эпикризе), с другой - сами пациенты тоже мало интересуются, чем их лечат или собираются лечить. В результате нередко нарушается преемственность в лечении пациентов на этапах стационар-поликлиника.

Результаты исследования грустные. В среднем один из 7 рекомендованных к приему препаратов пациенты не принимают вообще, чаще всего при этом выпадает анальгетик либо сердечно-сосудистый либо гастроинтестинальный препарат из рекомендованного перечня, половина пациентов были уверены в приеме препаратов, которые в действительности им не были назначены. Кто владеет english - читайте сами.

Patients Often Don't Know Which Drugs They're Prescribed in the Hospital

Patients are often unaware of which medications they're taking while in the hospital, according to a pilot study published online in the Journal of Hospital Medicine.
Fifty cognitively aware adults (mean age, 54) admitted to a teaching hospital compiled lists of the medications they believed they were prescribed during their admission. Their lists were then compared with the inpatient medication records. Among the findings:

• Nearly all patients left at least one prescribed medication off their list (average number of medications omitted, 7).
• The most commonly omitted medications included analgesics, gastrointestinal drugs, antibiotics, and cardiovascular drugs.
• Almost half of patients thought they were receiving a medication they were not prescribed.

The researchers write: "These results are a call to reexamine how we educate and involve patients regarding hospital medications," with the potential benefits of patients catching medication errors and having greater satisfaction with their care.
[Editor's note: This study has been released from embargo but has not yet been posted. Our link is to the Journal of Hospital Medicine's early-release page, where the article will appear shortly.]

Journal of Hospital Medicine early-release page (Free)
А вот и Brief Report самой статьи в журнале Journal of Hospital Medicine

Lack of patient knowledge regarding hospital medications Ethan Cumbler, MD, Heidi Wald, MD, MSPH, Jean Kutner, MD, MSPH Department of Medicine, University of Colorado Denver School of Medicine, Denver, Colorado email: Ethan Cumbler (Ethan.Cumbler@ucdenver.edu) *Correspondence to Ethan Cumbler, Mail Stop F782, 12401 East 17th Ave, Aurora, CO 80045 Disclosure: Dr. Cumbler, Dr. Kutner, and Dr. Wald have no relevant conflicts of interest for this manuscript. Telephone: 720-848-4289; Fax: 720-848-4293 Dr. Cumbler has no commercial interest relevant to this manuscript, has full access to all of the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. Funded by:  University of Colorado Hospital Clinical Excellence Grant KEYWORDS medical error • medication reconciliation • patient education • patient safety Received: 28 December 2008; Revised: 19 May 2009; Accepted: 26 May 2009 ARTICLE TEXT Inpatient medication errors represent an important patient safety issue. The magnitude of the problem is staggering, with 1 review finding almost 1 in every 5 medication doses in error, with 7% having potential for adverse drug events.[1] While mistakes made at the ordering stage are frequently intercepted by pharmacist or nursing review, administration errors are particularly difficult to prevent.[2] The patient, as the last link in the medication administration chain, represents the final individual capable of preventing an incorrect medication administration. It is perhaps surprising then that patients generally lack a formal role in detecting and preventing adverse medication administration events.[3] There have been some ambitious attempts to improve patient education regarding hospital medications and involve selected patients in the medication administration process. Such initiatives may result in increased patient participation and satisfaction.[4-7] There is also potential that increased patient knowledge of their hospital medications could promote the goal of medication safety, as the actively involved patient may be able to catch medication errors in the hospital. Knowledge of prescribed medications is a prerequisite to patient involvement in prevention of inpatient medication errors and yet there is little research on patient knowledge of their hospital medications. Furthermore, as the experience of hospitalization may be disorienting and disempowering for patients, it remains to be seen if patient attitudes toward participation in inpatient medication safety are favorable. To that end, we conducted a pilot study in which we assessed current patient awareness of their in-hospital medications and surveyed attitudes toward increased patient knowledge of hospital medications. PATIENTS AND METHODS We conducted a cross-sectional study of 50 cognitively intact adult internal medicine inpatients at the University of Colorado Hospital, a tertiary-care academic teaching hospital. This study was part of a larger project designed to examine potential for patient involvement in the medication reconciliation process. A professional research assistant approached eligible patients within 24 hours of admission. To be eligible, patients had to self-identify as knowing their outpatient medications, speak English, and have been admitted from the community. Nursing home residents and patients with a past medical history of dementia were excluded. Enrollment was tracked during the first half of the study to estimate effect of inclusion/exclusion criteria. Thirty-eight percent of hospital admissions to medicine services were excluded based on the specified criteria. Thirty-four percent of eligible patients were approached and 50% of approached patients agreed to participate in the study. Patient knowledge of their outpatient medication regimen was compared to admitting physician medication reconciliation to assess accuracy of patient self-report of outpatient medication knowledge. After consenting to participate, study patients completed a structured list of their outpatient medications and a survey of attitudes about being shown their in-hospital medications, hospital medication errors, and patient involvement in hospital safety. They then completed a list of the medications they believed to be prescribed to them in the hospital. The primary outcomes were the proportions of as needed (PRN), scheduled, and total hospital medications omitted by the patient, compared to the inpatient medication administration record (MAR) (patient errors of omission). Secondary outcomes included the number of in-hospital medications listed by the patient that did not appear on the inpatient MAR (patient errors of commission), as well as patient attitudes measured on a 5-point Likert scale (1 indicated strongly disagree and 5 indicated strongly agree). Descriptive data included age, race, gender, and number of inpatient medications prescribed. Separate analysis of variance (ANOVA) models provided mean estimates of the primary outcomes and tested differences according to each of the patient characteristics: age in years (<65 or 65), self-reported knowledge of hospital medications, and self-reported desire to be involved in medication safety. Similar ANOVA models adjusted for number of medications were also examined to determine whether the relationship between the primary outcomes according to patient characteristics were altered by the number of medications. The protocol was approved by the Colorado Multiple Institutional Review Board. RESULTS Participants averaged 54 years of age (standard deviation [SD] = 17, range = 21-89). Forty-six percent (23/50) were male, and 74% (37/50) were non-Hispanic white. Using a structured, patient-completed, outpatient medication list, patients in the study were on an average of 5.3 outpatient prescription medications (range = 0-17), 2.2 over-the-counter medications (range = 0-8), and 0.2 herbal medications (range = 0-7). The admitting physician's medication reconciliation list demonstrated similar number of outpatient prescription medications (average = 5.7) to the patient-generated list. Fifty-four percent of patient-completed home medication lists included all of the prescription medications on the physician's medication reconciliation at admission. According to the inpatient MAR, study patients were prescribed an average of 11.3 scheduled and PRN hospital medications (range = 2-26) at time of study enrollment. Patient Knowledge of Their Hospital Medication List Ninety-six percent (48/50) of study patients omitted 1 or more of their hospital medications. On average, patients omitted 6.8 medications (range = 0-22) (Table 1). Among scheduled medications, patients most commonly omitted antibiotics (17%), cardiovascular medications (16%), and antithrombotics (15%) (Figure 1). Among PRN medications, patients most commonly omitted analgesics (33%) and gastrointestinal medications (29%) (Figure 2). Table 1. Patient Knowledge of Their Hospital Medications List Total Medications Scheduled Medications PRN Medications Percent of patients with at least 1 hospital medication they could not name (95% CI) 96% (90-100%) 94% (87-100%) 80% (69-92%) Average number of hospital medications omitted by patient (range) 6.8 (0-22) 5.2 (0-15) 1.6 (0-7) Percentage of hospital medications omitted by patient (95% CI) 60% (52-67%) 60% (52-67%) 68% (57-78%)    NOTE: n = 50 patients.    Abbreviations: CI, confidence interval; PRN, as needed. Figure 1. From 260 omitted scheduled hospital medications by 50 study patients. [Normal View 17K | Magnified View 43K] Figure 2. From 78 omitted PRN hospital medications by 50 study patients. [Normal View 12K | Magnified View 28K] Patients less than 65 years omitted 60% of their PRN medications whereas patients greater than 65 years omitted 88% (P = 0.01). This difference remained even after adjustment for number of medications. There were no significant differences, based on age, in ability to name scheduled or total medications. Forty-four percent of patients (22/50) believed they were receiving a medication in the hospital that was not actually prescribed. Patient Attitudes Toward Increased Knowledge of Hospital Medications Only 28% (14/50) of patients reported having seen their hospital medication list, although 78% (39/50) favored being given such a list, and 81% (39/48) reported that this would improve their satisfaction with care. Ninety percent (45/50) wanted to review their hospital medication list for accuracy and 94% (47/50) felt patient participation in reviewing hospital medications had potential to reduce errors. No associations were found between self-reported knowledge of hospital medications or self-reported desire to be involved in medication safety and the proportion of PRN, scheduled, or total medications omitted. DISCUSSION Overall, patients in the study were able to name fewer than one-half of their hospital medications. Our study suggests that adult medicine inpatients believe learning about their hospital medications would increase their satisfaction and has potential to promote medication safety. At the same time, patients did not know many of their hospital medications and this would limit their ability to fully participate in the medication safety process. Study patients frequently committed both errors of omission (ie, they did not know which medications were prescribed), and errors of commission (ie, they believed they were prescribed medications that were not prescribed). Younger patients were aware of more of their PRN medications than older patients, potentially reflecting greater patient care involvement in younger generations. However, study patients, regardless of age, were able to name fewer than one-half of their PRN hospital medications. The most common scheduled hospital medications that patients were unable to name come from medication classes which can be associated with significant adverse events, including antibiotics, cardiovascular medications, and antithrombotics. We posit that without systematically educating patients about their hospital medications, significant deficits in patient knowledge are inevitable. Some might argue that patients should not be asked to know their hospital medications or identify medication errors while sick and vulnerable. Certainly with multiple medication changes, formulary substitutions, and frequent modifications based on changes in clinical status, inpatient medication education could be time consuming and potentially introduce patient confusion or anxiety. Incorrect patient feedback could have potential to introduce new errors. An educational program might use graded participation based on patient interest and ability. Models for this exist in the literature, even extending to patient medication self-administration.[5-7] In our sample of inpatients, the majority desired a more active role in learning about their hospital medications and believed that their involvement might prevent hospital medication errors from occurring. Medication literacy, education, and active patient involvement in medication monitoring as a means to improve patient outcomes has received significant attention in the outpatient setting, with lessons applicable to the hospital.[8][9] More broadly, the Joint Commission has established a Hospital National Patient Safety Goal to encourage patients' active involvement in their own care as a patient safety strategy.[10] Examples set forth by the Joint Commission include involving patients in infection control measures, marking of procedural sites, and reporting of safety concerns relating to treatment. While this study identifies patient knowledge deficit as a barrier to utilizing patients as part of the hospital medication safety process, it does not test whether reducing this knowledge deficit would actually reduce medication error. Our study population was limited to cognitively intact adult medicine patients at a single institution, limiting the generalizability of our conclusions. Our enrollment process may have resulted in a study population with less serious illness, greater knowledge of their hospital medications, and greater interest in participating in medication safety potentially overestimating patient knowledge of hospital medications. Finally, our small sample size limits the power to find differences in study comparisons. Our findings are striking in that we found significant deficits in patient understanding of their hospital medications even among patients who believed they knew, or desired to know, what is being prescribed to them in the hospital. Without a system to incorporate the patient into hospital medication management, these patients will be disenfranchised from participating in inpatient medication safety. These results are a call to reexamine how we educate and involve patients regarding hospital medications. Mechanisms to allow patients to provide feedback to the medical team on their hospital medications might identify errors or improve patient satisfaction with their care. However, the systems and cultural changes needed to provide education on inpatient medications are considerable. Future research is needed to determine if increasing patient knowledge regarding their hospital medications would reduce medication errors in the inpatient setting and how this could be effectively implemented. Acknowledgements We thank Sue Felton, MA, Professional Research Assistant, for enrolling patients in this trial, and Traci Yamashita, MS, Professional Research Assistant, for statistical analysis. REFERENCES 1 Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 health care facilities. Arch Intern Med . 2002; 162: 1897-1903. Links 2 Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA . 1995; 274: 29-34. Links 3 Vincent CA, Coulter A. Patient Safety: what about the patient? Qual Saf Health Care . 2002; 11: 76-80. Links 4 Calabrese AT, Cholka K, Lenhart SE, et al. Pharmacist involvement in a multidisciplinary inpatient medication education program. Am J Health Syst Pharm . 2003; 60: 1012-1018.Links 5 Phelan G, Kramer EJ, Grieco AJ, Glassman KS. Self-administration of medication by patients and family members during hospitalization. Patient Educ Couns . 1996; 27: 103-112.Links 6 Wright J, Emerson A, Stephens M, Lennan E. Hospital inpatient self-administration of medicine programmes: a critical literature review. Pharm World Sci . 2006; 28: 140-151. Links 7 Manias E, Beanland C, Riley R, Baker L. Self-administration of medication in hospital: patients' perspectives. J Adv Nurs . 2004; 46: 194-203. Links 8 Budnitz DS, Layde PM. Outpatient drug safety: new steps in an old direction. Pharmacoepidemiol Drug Saf . 2007; 16: 160-165. Links 9 Keller DL, Wright J, Pace HA. Impact of health literacy on health outcomes in ambulatory care patients: a systematic review. Phamacosociology . 2008; 42: 1272-1281. Links 10 Joint Commission. 2009. Standards Improvement Initiative. Available at: http://www.jointcommission.org/NR/rdonlyres/31666E86-E7F4-423E-9BE8-F05BD1CB0AA8/0/HAP_NPSG.pdf. Accessed June 2009.

Все отчетливее проявляется связь прогрессии атеросклероза с хроническим воспалением интимы и эндотелия сосудов. Крестор одобрен FDA для назначения при нормальном уровне холестерина и признаках активности воспаления

Пока одобрен только крестор (ЮПИТЕР виноват!). Полагаю. за остальными статинами дело не станет.

FDA Advisers Recommend Expanding Crestor to Patients Without High Cholesterol

An FDA advisory panel voted 12 to 4 on Tuesday to expand the use of rosuvastatin (Crestor) to patients with normal cholesterol levels and no history of cardiac disease, according to the Associated Press.

The panel's recommendation was based on last year's JUPITER trial, in which rosuvastatin cut cardiovascular risk in patients with normal LDL cholesterol but high C-reactive protein levels.

The manufacturer said it "would focus on marketing the drug to patients with health issues that put them at increased risk of heart problems, such as a smoking habit or family history of hypertension," the AP reports.

The FDA is expected to make its decision in early 2010.

Associated Press story (Free)

Physician's First Watch coverage of the JUPITER (Free)

Надо пересмотреть отношение к депрессии как фактору риска ССЗ

По крайней мере, трициклические антидепрессанты не снижают смертность от ССЗ, риск геморрагического инсульта возростает на 45%, смертность от всех причин - также растет на фоне длительного использования антидепрессантов.

Перевод статьи и заметки - позднее.

Antidepressants Linked to Higher Risk for Stroke, Death Among Postmenopausal Women

Antidepressant use is associated with increased risk for stroke and all-cause mortality among postmenopausal women, Archives of Internal Medicine reports.

Researchers prospectively followed, for about 6 years, some 136,000 Women's Health Initiative participants who weren't using antidepressants at baseline. They compared cardiovascular outcomes between women who started using antidepressants during follow-up (4%) and those who did not.

Among the findings:

• Antidepressants were not associated with coronary heart disease.
• SSRIs were associated with a 45% increase in stroke risk, largely due to an increase in hemorrhagic stroke (consistent with SSRI's antiplatelet effects, the authors note).
• SSRIs and tricyclic antidepressants conferred higher risk for all-cause mortality.

The authors caution that their findings "must be placed in the context of the observational nature of these analyses ... and the known risks associated with depression."

Archives of Internal Medicine article (Free abstract; full text requires subscription)

Archives of Internal Medicine commentary (Subscription required)

Видео от Медицинского журнала Новой Англии - лодыжечно-плечевой индекс

Ankle–Brachial Index for Assessment of Peripheral Arterial Disease

S. Marlene Grenon, M.D.C.M., Joel Gagnon, M.D., and York Hsiang, M.D.

Пероральные сахароснижающие препараты неравнозначны по влиянию на риск ИМ и других серьезных осложнений ИБС.

Дьявольски интересное сообщение. Переведу позднее. Пока читайте на английском. Полный текст статьи по ссылке

Published 3 December 2009, doi:10.1136/bmj.b4731
Cite this as: BMJ 2009;339:b4731

Research

Risk of cardiovascular disease and all cause mortality among patients with type 2 diabetes prescribed oral antidiabetes drugs: retrospective cohort study using UK general practice research database

Ioanna Tzoulaki, lecturer¹, Mariam Molokhia, senior lecturer², Vasa Curcin,research associate³, Mark P Little, reader¹, Christopher J Millett, senior lecturer in public health⁴, Anthea Ng, research associate⁴, Robert I Hughes,research associate⁵, Kamlesh Khunti, professor⁶, Martin R Wilkins,professor⁵, Azeem Majeed, professor⁴, Paul Elliott, professor^1,7

¹ Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, London W2 1PG, ² Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London,³ Department of Computing, Imperial College London, London,, ⁴ Department of Primary Care and Social Medicine, Imperial College London, London, ⁵Department of Experimental Medicine and Toxicology, Imperial College London, London, ⁶ Department of Health Sciences, University of Leicester, Leicester, ⁷ MRC-HPA Centre for Environment and Health, London

Correspondence to: P Elliott p.elliott@imperial.ac.uk

Objective To investigate the risk of incident myocardial infarction, congestive heart failure, and all cause mortality associated with prescription of oral antidiabetes drugs.

Design Retrospective cohort study.

Setting UK general practice research database, 1990-2005.

Participants 91 521 people with diabetes.

Main outcome measures Incident myocardial infarction, congestive heart failure, and all cause mortality. Person time intervals for drug treatment were categorised by drug class, excluding non-drug intervals and intervals for insulin.

Results 3588 incident cases of myocardial infarction, 6900 of congestive heart failure, and 18 548 deaths occurred. Compared with metformin, monotherapy with first or second generation sulphonylureas was associated with a significant 24% to 61% excess risk for all cause mortality (P<0.001) and second generation sulphonylureas with an 18% to 30% excess risk forcongestive heart failure (P=0.01 and P<0.001). The thiazolidinediones were not associated with risk of myocardial infarction; pioglitazone was associated with a significant 31% to 39% lower risk of all cause mortality (P=0.02 to P<0.001) compared with metformin. Among the thiazolidinediones, rosiglitazone was associated with a 34% to 41% higher risk of all cause mortality (P=0.14 to P=0.01) compared with pioglitazone. A large number of potential confounders were accounted for in the study; however, the possibility of residual confounding or confounding by indication (differences in prognostic factors between drug groups) cannot be excluded.

Conclusions Our findings suggest a relatively unfavourable risk profile of sulphonylureas compared with metformin for all outcomes examined. Pioglitazone was associated with reduced all cause mortality compared with metformin. Pioglitazone also had a favourable risk profile compared with rosiglitazone; although this requires replication in other studies, it may have implications for prescribing within this class of drugs.

А вот и перевод поспел...

Риск развития осложений ССЗ и смертности от всех причин у пациентов с сахарным диабетом 2 типа на фоне приема пероральных сахароснижающих препаратов: ретроспективное когортное исследование данных общеврачебной практики в Соединенном Королевстве (Великобритания).

Иоанна Цулаки, Мариам Молокаи, Ваза Курцин и др.
Департамент эпидемиологии и общественного здравоохранения, медицинский факультет, Имперский колледж, Лондон

Цель исследования: изучение рисков развития ИМ, застойной сердечной недостаточности и смерти от всех причин в зависимости от  назначения перорального сахароснижающего препарата.
Дизайн: ретроспективное когортное исследование
Источник сведений: национальная база данных общеврачебной практики  в Соединенном Королевстве (Великобритания), период 1990-2005 гг.
Общее число пациентов, включенных в исследование: 91 521 больной с сахарным диабетом 2 типа
Основные критерии оценки результатов лечения ("конечные точки"): случаи ИМ, случаи развития застойной сердечной недостаточности, случаи смерти от всех причин
Результаты: в исследуемой популяции было зарегистрировано 3 588 случаев ИМ, 6 900 случаев развития застойной сердечной недостаточности и 18 548 случаев смерти. В сравнении  с терапией метформином отмечено достоверное увеличение числа случаев смерти от всех причин на фоне монотерпии препаратами сульфонилмочевины первой и второй генерации (с 24% до 61%; р<0.001), а также увеличение числа случаев развития застойной сердечной недостаточности на фоне монотерапии препаратами сульфонилмочевины второго поколения (с 18% до 30%; p<0.001). Назанчение тиазолидиндионов не ассоциировалось с увеличением числа случаев ИМ; пиоглитазон достоверно снижал риск смерти от всех причин в сравнении с назначением метформина (31% и 39% соответственно, р<0.001). В группе тиазолидиндионов розиглитазон ассоциировался с более высоким уровнем смертности от всех причин в сравнении с пиоглитазоном (41% и 34% соответственно, р= 0,01 и р=0,14). В исследовнии учитывалось большое количество ко-факторов, влияющих на исходы заболеваний, что не позволило исключить их значение для результатов исследования.
Выводы: исследование показало относительно низкую эффективность использования препаратов сульфонилмочевины в сравнении с метформином в отношении всех учтенных неблагоприятных исходов ССЗ при диабете 2. Пиоглитазон ассоциировался со снижением смертности в сравнении с назначением метформина. Пиоглитазон также имел лучший рисковый профиль в сравнении розиглитазоном, что требует проведения дополнительных уточняющих исследований перед его признанием в качестве приоритетного препарата для предупреждения осложнений ССЗ при сахарном диабете 2 типа.

Примечание: торговые наименования метформина (международное непатентованное название) -  Багомет^®, Глиминфор, Глиформин, Глюкофаж^®, Диаформин, Метоспанин, Метфогамма^®, Метформин, Метформина гидрохлорид, НовоФормин, Сиофор^®, Форметин, Формин Плива.
Напомним, что метформин - единственный разрешенный в РФ препарат из группы бигуанидов (препаратов, препятствующих развитию гипергликемии, но не снижающих уровень сахара в крови и не стимулирующих секрецию инсулина)
Производные сульфонилмочевины первого поколения (карбутамид, толбутамид, хлорпропамид, толазамид) в настоящее время практически не используются; производные сульфонилмочевины второго поколения  ( гликвидон , гликлазид ,  глибенкламид , глипизид , глимепирид ), напротив, используются в РФ очень широко.


Тиазолиндионы, они же - глитазоны (пиоглитазон, росиглитазон) стимулируют рецепторы, расположенные в ядрах клеток жировой и мышечной ткани. При их активации изменяется транскрипция генов, регулирующих метаболизм глюкозы и липидов. В результате периферические ткани организма более эффективно отвечают на эндогенный инсулин.

Пиоглитазон (Актос, Диаб-норм, Пиоглар) принимается внутрь, 1 раз в сутки независимо от приёма пищи. Начальная доза — 15–30 мг, максимальная суточная — 45 мг, максимальная доза при комбинированной терапии — 30 мг/сут.

Росиглитазон (Авандия, Роглит) принимается внутрь 1-2 раза в сутки независимо от приёма пищи. Начальная доза — 4 мг/сут., максимальная суточная — 8 мг, максимальная доза при комбинированной терапии — 4 мг/сут.
Очень любопытная ссылка по истории одного из тиазолиндионов-глитазонов
Розиглитазон: история с продолжением

Великолепная статья (все о сахароснижающих пероральных препаратах)
ПЕРОРАЛЬНЫЕ САХАРОСНИЖАЮЩИЕ ПРЕПАРАТЫ В ЛЕЧЕНИИ САХАРНОГО ДИАБЕТА ТИПА 2