[Coming clinical recommendations: where will the glitazones fit in?]

The recommendations for antidiabetic treatment in type 2 diabetes were published by AFSSAPS (Agence Française de Sécurité Sanitaire des Produits de Santé) in 1999. These recommendations, as well as those published by ANAES (Agence Nationale d'Accréditation et d'Evaluation en Santé), indicate an optimal objective for ("good") glycemic control to be an HbA1c level< or =6,5%. These recommendations include two decision trees, according to body mass index (< 28 kg/m2 or >28 kg/m2). Since their publications, our knowledge on diabetes pathophysiology and evolution from insulin resistance to type 2 diabetes, on the progressive decline of pancreatic beta-cell function, and on the close relationships between insulin resistance, type 2 diabetes and cardiovascular diseases, have increased and became more precise. Moreover, new approaches emerged, particularly the importance of the metabolic syndrome and the unfavorable role of visceral fat, when intervention studies (DPP, STOP-NIDDM) demonstrate the possibility to delay and/or to prevent type 2 diabetes. Finally, new oral antidiabetic agents (meteglinides and thiazolidinediones), as well as availability of long-acting insulin analogues, lead to the necessity to update current recommendations. This review, presents and discuss these various points, and the questions they generate, which have to be answer to update the therapeutic recommendations for type 2 diabetes.