A 45 year old female patient comes to the clinic for routine general checkup. She is a known diabetic and is on oral hypoglycaemic drug (Gliconil). On general examination truncal obesity is seen. The agent used in the treatment of this patient acts by inhibiting which of the following ?

**Core Concept**
The patient is likely experiencing insulin resistance due to truncal obesity, a common feature of polycystic ovary syndrome (PCOS) or metabolic syndrome. Gliconil, an oral hypoglycemic drug, is used to manage type 2 diabetes mellitus.

**Why the Correct Answer is Right**
Gliconil is a thiazolidinedione (TZD) class of medication, which acts by activating peroxisome proliferator-activated receptor-gamma (PPAR-γ). Activation of PPAR-γ increases the expression of genes involved in glucose and lipid metabolism, leading to improved insulin sensitivity. This action helps to reduce insulin resistance, thereby lowering blood glucose levels.

**Why Each Wrong Option is Incorrect**
* **Option A:** This option is incorrect as it refers to a different class of medications, such as sulfonylureas, which act by stimulating insulin release from the pancreatic beta cells.
* **Option B:** This option is incorrect as it refers to a class of medications like DPP-4 inhibitors, which act by inhibiting dipeptidyl peptidase-4, thereby increasing the levels of incretin hormones that stimulate insulin release.
* **Option C:** This option is incorrect as it refers to a different class of medications, such as alpha-glucosidase inhibitors, which act by inhibiting the intestinal absorption of glucose.

**Clinical Pearl / High-Yield Fact**
TZDs like gliconil are known to have a risk of fluid retention and heart failure, particularly in patients with pre-existing cardiac conditions. It is essential to monitor patients closely for signs of fluid retention and adjust the medication or discontinue it if necessary.

**Correct Answer:** C. PPAR-γ.

✓ Correct Answer: C. CPT-I