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Insulin resistance is an important mechanism in the development of the insulin resistance syndrome and type 2 diabetes. Although treatment has hitherto been confined to metformin or non-pharmacological measures, efforts are now being made to discover new drugs active against insulin resistance, so-called insulin sensitisers, for instance among the thiazolidinedione group. These are beginning to be tested in larger clinical trials where they have manifested effects not only on glucose metabolism but also on other cardiovascular risk factors such as hyperlipidaemia, defective fibrinolysis, and hypertension. However, adverse reactions to one of these drugs, troglitazone, include severe hepatic effects in certain cases. Accordingly, registration of the product has been stopped for use in Europe, but not in the USA and Japan. It is likely to take some time before thiazolidinediones will be introduced for clinical use in this country, though research and development continue.