Q: What are the advantages of using therapy of Pioglitazone over Rosiglitazone? Does Pioglitazone scores over Nateglinide/Repaglinide in certain areas?If yes, which are those?

A:Both Pioglitazone and Rosiglitazone are equal in their effectiveness. In fact Rosiglitazone has a blood pressure lowering property also. Both these drugs are sort of reserve medicines and should only be used if conventional therapy is either not effective or not tolerated i.e one of the sulphonylureas such as Glipizide (Glipicontin Continus 5 or 10mg) with Metformin (Glyciphage 500 or 850mg). In any event both Pioglitazone and Rosiglitazone must be used concurrently with either Glipizide or Metformin. They are not allowed to be used alone. Repaglinide and Nateglinide belong to an altogether different group called Prandial Glucose Regulators. These drugs should be used only when conventional therapy fails. They have a rapid onset and short duration of action. They are taken in the following cases only: * Patients whose blood sugar goes down very much when treated with a sulphonylurea (such as Glipizide), or * when the blood sugar goes very high after meals, or * patients with erratic meal timings because long-acting agents will produce low blood sugar levels when they do not take meals. These agents are suitable for very specific patients where frequent post-meal blood sugar levels have to be taken. They have to be taken alone on their own.