ADOPT suggests that rosiglitazone, ahead of traditional therapies, can meet patient needs with respect to long-term glycaemic control, yet the recent safety debate, stimulated by retrospective meta-analysis, has seriously affected physician confidence to use it. Other recent evidence, including from a number of long-term outcome studies, does not confirm or exclude a cardiovascular risk signal for rosiglitazone, and evaluation of this data has led EMEA to support continued use of rosiglitazone, albeit with a recommendation not to use in patients with a previous cardiovascular history. Where does this leave us? Rosiglitazone remains the only oral blood glucose lowering agent to have demonstrated nearly 5 years of blood glucose control. Patients earlier in their disease, free of known cardiovascular disease, are just the patients to benefit most from long term glucose target achievement.
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