Xiao Wang, 30 years old, his family is well-off, free and easy, typical of the rich second generation. His waist circumference of 175cm is 3 feet 3, his weight has reached 100kg, to give people a “sense of security” everywhere. However, recently he spent the whole day frowning, sighing, two words: depressed! What is going on? It turns out that his father, the chairman of a large company, was admitted to the ICU with a sudden acute myocardial infarction and just got out of life-threatening conditions. This is not in charge of Dr. Zhang to confide in the family’s condition, he drove his BMW sports car all the way to the hospital at speed. Dr. Zhang met Xiao Wang for the first time to confess his condition. His father is currently diagnosed with coronary heart disease acute myocardial infarction, type 2 diabetes, hypertension, hyperlipidemia, hyperuricemia, fatty liver, and obesity. After active resuscitation condition is stable, he can be transferred to the cardiac general ward soon, but there is still a risk of another heart attack or a brain infarction. Xiao Wang had mixed feelings and wondered how his father, who is usually in good health, could have a sudden heart attack! Dr. Zhang looked at Xiao Wang and said, “His high blood sugar, hypertension, hyperlipidemia, obesity, high uric acid, frequent socializing, smoking and drinking, and few car transportation activities are all very high risk factors for cardiovascular disease. Dr. Zhang took a look at Wang and said “young man, your father has these problems, from genetics and now your appearance, it is recommended that you recently do a comprehensive physical examination, perhaps the results will make you unexpected!” Wang thought of his father’s danger soon completed a physical examination under the guidance of Dr. Zhang, and was really surprised! Fasting blood sugar 7.7mmol/L, glycosylated hemoglobin has reached 7.5%, while blood pressure, lipids, uric acid, are beyond normal, and the diagnosis of type 2 diabetes, accompanied by significant hyperinsulinemia, was clearly established by the glucose tolerance test and islet function measurement. The many problems entangled together are typical of metabolic syndrome, and the etiology is insulin resistance. Dr. Zhang analyzed them one by one and emphasized the addition of rosiglitazone maleate 1 tablet daily on the basis of lifestyle intervention to control blood sugar, improve insulin resistance and prevent cardiovascular and cerebrovascular complications in the long term. Wang readily accepted, adhered to diet control and exercise, and after three months of medication glycated hemoglobin dropped to 6.1%, meeting the standard! The global epidemic of type 2 diabetes has become a world problem, and the prevalence of adult diabetes and prediabetes in China has reached 9.7% and 15.5%, respectively, and increases significantly with age, and has become a major public health problem. Epidemiological studies have found that obesity is the starting point of the natural course of type 2 diabetes. 60-80% of patients with type 2 diabetes are obese, and 94% of diabetes is caused by obesity. Studies have confirmed that obesity can lead to insulin resistance, which is the driving factor in the development of type 2 diabetes. “Insulin resistance is the basis for the pathogenesis of diabetes and metabolic syndrome, and it precedes beta-cell dysfunction and continues throughout the course of diabetes. Through the metabolic abnormalities caused by insulin resistance and the non-metabolic effects of hyperinsulinemia, it causes clinical syndromes such as obesity, hyperlipidemia, hyperglycemia, hypertension, hyperuricemia, and ultimately cardiovascular diseases. The UK Prospective Diabetes Study (UKPDS) showed that blood glucose levels were strongly associated with complications, with each 1% reduction in glycosylated hemoglobin resulting in a significant reduction in any of the diabetes-related endpoints (-21%), microvascular endpoints (-37%), myocardial infarction (-14%), and diabetes-related death (-21%). At their follow-up, the risk of microvascular disease was consistently reduced in the intensive group, and the risk of myocardial infarction and all-cause death was also significantly reduced in the intensive group, despite similar and suboptimal blood glucose levels in both the original intensive and conventional treatment groups. This suggests that there is a metabolic memory effect for the benefit of early glycemic control, and it is more important to treat the disease before it occurs! Rosiglitazone maleate, a new generation of thiazolidinediones, improves glycemic control in patients with type 2 diabetes by enhancing insulin sensitivity and selectively acting on metabolic, vascular, and inflammatory factors. The drug mediates its therapeutic effects by activating peroxisome proliferator-activated receptor γ (PPARγ), which is widely distributed in adipose, muscle, liver, kidney, and islet tissues. Rosiglitazone increases adipogenesis, and the newly generated small adipocytes are insulin-sensitive and can bind fatty acids to reregulate the glucose-fatty acid cycle, facilitating glucose utilization by muscle tissue while reducing free fatty acids in the blood. In addition, rosiglitazone redistributes fat, increasing subcutaneous fat and decreasing visceral fat content. Expression of PPARγ in different tissues confers the pleiotropic nature of rosiglitazone’s action, allowing it to target the underlying pathophysiological processes and microvascular complications of diabetes. More notably, rosiglitazone reduces β-cell apoptosis and delays the progression of prediabetes to diabetes. It can both intervene early to prevent and delay the onset of diabetes in people at risk of diabetes, and has a longer expiration period compared to other hypoglycemic agents. Therefore, it is suitable for all stages of the course of diabetes, with 4mg-8mg (1 to 2 tablets) daily, and generally takes effect in 1 month, and achieves a very good glucose-lowering effect in 2-3 months. After Xiao Wang’s father was discharged from the hospital, everything was smooth, Xiao Wang’s blood sugar was stable, he adhered to his medication and his smile returned to his face.