Insulin sensitizers in 2023: lessons learned and new avenues for investigation

Jerry R. Colca, Steven P. Tanis, Rolf F. Kletzien, Brian N. Finck

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations


Introduction: ‘Insulin sensitizers’ derived discoveries of the Takeda Company in 1970s. Pioglitazone remains the best in class with beneficial pleiotropic pharmacology, although use is limited by tolerability issues. Various attempts to expand out of this class assumed the primary molecular target was the transcription factor, PPARγ. Findings over the last 10 years have identified new targets of thiazolidinediones (TZDs) that should alter the drug discovery paradigm. Areas covered: We review structural classes of experimental insulin sensitizer drugs, some of which have attained limited approval in some markets. The TZD pioglitazone, originally approved in 1999 as a secondary treatment for type 2 diabetes, has demonstrated benefit in apparently diverse spectrums of disease from cardiovascular to neurological issues. New TZDs modulate a newly identified mitochondrial target (the mitochondrial pyruvate carrier) to reprogram metabolism and produce insulin sensitizing pharmacology devoid of tolerability issues. Expert opinion: Greater understanding of the mechanism of action of insulin sensitizing drugs can expand the rationale for the fields of treatment and potential for treatment combinations. This understanding can facilitate the registration and broader use of agents with that impact the pathophysiology that underlies chronic metabolic diseases as well as host responses to environmental insults including pathogens, insulin sensitizer, MPC, mitochondrial target, metabolic reprogramming, chronic and infectious disease.

Original languageEnglish
Pages (from-to)803-811
Number of pages9
JournalExpert Opinion on Investigational Drugs
Issue number9
StatePublished - 2023


  • Insulin sensitizer
  • MPC
  • MSDC-0160
  • chronic and infectious disease
  • metabolic reprogramming
  • mitochondrial target
  • pioglitazone
  • rosiglitazone


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