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Shown that subjects with type 2 diabetes experience diminished orthostatic tolerance during heat exposure.11 Cardiovascular autonomic neuropathy has been defined as an abnormality associated with heart-rate control and vascular dynamics.20 Cardiovascular autonomic dysfunction has also been associated with an increased rate of mortality in patients with type 2 diabetes.21 In patients with type 2 diabetes, a blunted response of circulating levels of norepinephrine in response to standing as well as diminished responsiveness of the carotid baroreceptors can occur.11, 22-26 A key factor in maintaining adequate compensatory blood pressure response to standing are intact baroreceptor reflexes.27 Heat exposure reduces the carotid baroreflex responsiveness.28 Thus, in patients with type 2 diabetes, orthostasis is aggravated further by heat exposure. This central adrenergic impairment was replicated again in our diabetic cohort, in the present investigation, and correlated with diminished cutaneous dermal vascular blood flow and more importantly, showed improvement with Avamdia administration. Endothelial cell function was also assessed simultaneously with dermal vascular function in this group and was also found to be altered. Critical to the health of the vasculature is a properly function endothelium. The endothelium is critical to maintaining a positive balance of opposing states such as coagulation, fibrinolyis, thrombosis, inflammation and oxidation.29 When the endothelium is healthy, it is resistant to clotting and penetration by monocytes, which form an atheromatous plaque.16 Healthy endothelium also results in nitric oxide formation, which then results in vasodilation. Previous attempts to look at the contribution of the vascular endothelium to dermal microcirculation failed to. Dosage: Rosiglitazone has a starting dose of 4 mg day, with maintenance doses of 2-8 mg day given in 1 or divided doses. Dosage increases may be made if patients have inadequate response following 8-12 weeks of treatment. Renal Impairment: No dose adjustment necessary. Hepatic Impairment: Do not use if patient has active live disease or increased serum transaminase levels ALT 2.5x upper limit of normal ; . Monitoring: HbA1c, FBG, LFT's. Warnings Contraindications: Class III or IV heart failure not recommended due to fluid retention ; , liver disease, type 1 diabetes mellitus ineffective without insulin ; . Adverse Effects: Weight gain, fluid retention, headache, anemia. Safety in Pregnancy: C Comments: It may take several weeks for onset of action and several months for peak activity. Requires the presence of insulin for action. Approved for use in triple combination therapy with secretagogue plus metformin ; . Dosage Forms: 2 mg, 4 mg, 8 mg tablets. Website: vandia and biaxin.

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