An open level study to assess the glycemic control effect of metformin and Pioglitazone as add on therapy along with sulfonylurea in uncomplicated type2 … (original) (raw)
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Journal of Diabetes Mellitus, 2012
Introduction: Management of hyperglycemia in type2 diabetes mellitus (T2DM) becomes the top priority. When single antidiabetic drug is ineffective, combination is required for good glycemic control. There is a dearth of studies that provide head to head comparison of the ability of combinations and therefore need further study. Objectives: To assess and compare the glycemic control and physical parameter altering effect of glibenclamide, glibenclamide & Pioglitazone, glibenclamide & metformin in T2DM. Methods and materials: 100 T2DM patients were selected from outpatients department of medicine following prefixed inclusion and exclusion criteria. Fasting and postprandial blood glucose (fbg & ppbg) and physical parameters (waist, hip and thigh circumference) were measured before and after treatment with study drugs and adverse effects of these drugs were recorded. Data were analyzed by employing paired t-test and chi-square test. Results: 11 patients lost the follow up. A some total of 89 middle aged, predominantly male, non obese T2DM patients after exposure to the study drugs showed significant (p < 0.05) reduction of blood glucose from baseline. Reduction of blood glucose and waist:hip ratio were observed significantly (p < 0.05) more with glibenclamide and metformin combination with some tolerable side effects. Discussion: Metformin and Pioglitazone both are insulin sensitizer but metformin & glibenclamide combination showed significantly (p < 0.001) more reduction of fbg, ppbg and central obesity (waist: hip ratio) than Pioglitazone & glibenclamide combination. Therefore Judicious use of low dose of glibenclamide and full dose of metfor-min become safe, effective and cheap for the treatment of type 2 diabetes patients in poor country like India.
Journal of Diabetes Mellitus, 2012
Insulin therapy cause weight gain and may increase its own requirement. Type 2 diabetes mellitus is associated with insulin resistance and affect both endogenous and exogenous insulin effect. Metformin and Pioglitazone, commonly used insulin sensitizers, have the potentiality of reducing the insulin dose, in Type 2 diabetes mellitus (T2DM) patients. This study was held to assess and compare such potentiality. 40 T2DM patients not controlled by diet, exercise and oral antidiabetic agents were selected for this study. Study had observed that Pioglitazone and metformin both significantly had reduced the dose of insulin. But metformin reduce the dose of insulin significantly more than that of Pioglitazone. Metformin had reduced the triglyceride, LDL-c, waist hip ratio significantly but modestly increased serum lactic acid and HDL-c. It can be concluded that co-administration of metformin with insulin is more beneficial in relation to the dose of insulin, waist hip ratio, and lipid modification when compare to Pioglitazone.
The Journal of the Association of Physicians of India, 2003
The thiazolidinediones are a class of antidiabetes medication that enhance the actions of insulin in muscle, liver, and adipose tissue. Data have been lacking on their use in combination with both sulfonylurea and metformin among patients of type 2 diabetes who are on insulin therapy secondary to failure of routine oral hypoglycemic drugs in controlling their diabetes. To determine the effects of pioglitazone in combination with sulphonylurea and metformin on diabetes control in patients being treated with insulin due to secondary failure of oral hypoglycemic agents. One hundred and twenty-four consecutive type 2 diabetes patients (mean age, 57.13 years) attending four centres in Mumbai, who were being treated with insulin were selected. They were switched on to triple drug combination of glibenclamide 5 mg, metformin 500 mg and pioglitazone 15 mg along with insulin. Study participants were required to have type 2 diabetes mellitus for atleast 5 years. Patients were excluded if they...
The Journal of the Association of Physicians of India, 2007
To study the effects of pioglitazone and metformin combination in type 2 diabetics in achieving long-term optimal glycemic control. Patients whose duration of type 2 diabetes was less than 24 months were selected for the study. 373 such patients meeting the selection criteria were included in the study and were started on triple drug combination therapy. Three hundred seventy three (183 females and 190 males) patients were initiated on a triple drug combination of gliclazide 80 mg, tid, metformin 500 mg tid and pioglitazone 30 mg od. Once controlled, the doses of gliclazide were reduced if the blood glucose levels decreased. Those patients whose plasma glucose remained in the normal range for more than 6 months without the use of a sulphonylurea were considered to be in pharmacological remission. 48 patients were lost to follow up. At the beginning of the study the pre treatment biochemical parameters in these 325 diabetic patients at the time of enrolment were: average FBG of 209.4...
The Journal of Clinical Endocrinology & Metabolism, 2003
Pioglitazone, a thiazolidinedione, improves glycemic control primarily by increasing peripheral insulin sensitivity in patients with type 2 diabetes, whereas metformin, a biguanide, exerts its effect primarily by decreasing hepatic glucose output. In the first head-to-head, double-blind clinical trial comparing these two oral antihyperglycemic medications (OAMs), we studied the effect of 32-wk monotherapy on glycemic control and insulin sensitivity in 205 patients with recently diagnosed type 2 diabetes who were naive to OAM therapy. Subjects were randomized to either 30 mg pioglitazone or 850 mg metformin daily with titrations upward to 45 mg (77% of pioglitazone patients) and 2550 mg (73% of metformin patients), as indicated, to achieve fasting plasma glucose levels of less than 7.0 mmol/liter (126 mg/dl). Pioglitazone was comparable to metformin in improving glycemic control as measured by hemoglobin A1C and fasting plasma glucose. At endpoint, pioglitazone was significantly more effective than metformin in improving indicators of insulin sensitivity, as determined by reduction of fasting serum insulin (P ؍ 0.003) and by analysis of homeostasis model assessment for insulin sensitivity (HOMA-S; P ؍ 0.002). Both OAM therapies were well tolerated. Therefore, pioglitazone and metformin are equally efficacious in regard to glycemic control, but they exert significantly different effects on insulin sensitivity due to differing mechanisms of action. The more pronounced improvement in indicators of insulin sensitivity by pioglitazone, as compared with metformin monotherapy in patients recently diagnosed with type 2 diabetes who are OAM-naive, may be of interest for further clinical evaluation.
Endocrine Research, 2012
Objectives. This study aims to evaluate the efficacy and safety of adding pioglitazone to treatment with metformin (MF) and gliclazide in patients with type 2 diabetes mellitus (DM2) who had inadequate glycemic control. Methods. This study is a retrospective cohort study based on King Abdullah University Hospital records concerning type 2 diabetic adult patients for year 2008. Patients included were assessed according to changes in glycosylated hemoglobin (HbA1c), lipid profile, albuminuria and liver enzymes before and after the addition of pioglitazone. Results. The patients included in the study had an initial mean HbA1c of 9.44%, which decreased to 7.56% after the addition of pioglitazone (P-value < 0.005).
Journal of Evolution of medical and Dental Sciences, 2015
BACKGROUND & OBJECTIVES: Diabetes, heart disease, stroke and some types of cancer are the most common preventable chronic diseases observed in the modern society. Prevalence of type 2-diabetes is increasing in most of the countries, especially in developing countries such as India (67millions approx.) Metformin, glimepiride & pioglitazone are the most common ant diabetic drugs used. SETTINGS, METHODS AND MATERIAL: The study was undertaken in R.G. Kar Medical College and Hospital, Kolkata, India. The study population was obtained from the weekly diabetic clinic. Type-2 DM patients, with uncontrolled plasma glucose, determined by anyone of FBS >130mg/dl, PPBS >180mg/dl, and HbA1c >7% with a combination therapy of Metformin (1000mg) & Glimepiride (2mg) for at least 4wks and then treated with either additional Metformin (500mg) or Pioglitazone (15mg) as add-on therapy were included in the study. HbA1C levels were measured twice, first baseline level during inclusion and then af...
Journal of Diabetes Mellitus, 2012
Introduction: Impaired glucose tolerance (IGT) often leads to type 2 diabetes (T2DM) and macro vascular disease; and usually associated with insulin resistance. Pioglitazone and metformin are commonly used insulin sensitizers (IS); and can prevent or delay the development T2DM and macro vascular disease. This study was deployed to search the better IS between these two in relation to plasma glucose and lipid control; and physical parameter altering effect. Materials and Methods: 100 IGT patients selected randomly from outpatients department following prefixed inclusion and exclusion criteria. Pioglitazone and metformin were administered sequentially. Washout period was 2 weeks. Total follow up period was 24 weeks. Results: 70 IGT patients had completed the study. Metformin had reduced plasma glucose (fasting & postprandial), lipids and physical parameters significantly (p < 0.05) more than Pioglitazone. Discussion: Metformin, a hepatic insulin sensitizer, is more effective than PPAR-ϒ agonist Pioglitazone in the treatment of IGT; and this is due to the expression of PPAR-ϒ is more in adipose tissue but postprandial utilization of plasma glucose is more in muscle tissue.
Diabetes-metabolism Research and Reviews, 2005
BackgroundThis 52-week, randomized, double-blind study compared the efficacy and safety of metformin plus pioglitazone with the established combination of metformin plus gliclazide in type 2 diabetes mellitus.This 52-week, randomized, double-blind study compared the efficacy and safety of metformin plus pioglitazone with the established combination of metformin plus gliclazide in type 2 diabetes mellitus.MethodsPatients with poorly controlled type 2 diabetes (HbA1c ≥ 7.5% to ≤11.0%) received either pioglitazone 15 mg o.d. (titrated up to 45 mg; n = 317) or gliclazide 80 mg o.d. (titrated up to 320 mg; n = 313) and metformin at the pre-study dose. HbA1c, fasting plasma glucose (FPG), insulin, lipids and the urinary albumin/creatinine ratio were measured.Patients with poorly controlled type 2 diabetes (HbA1c ≥ 7.5% to ≤11.0%) received either pioglitazone 15 mg o.d. (titrated up to 45 mg; n = 317) or gliclazide 80 mg o.d. (titrated up to 320 mg; n = 313) and metformin at the pre-study dose. HbA1c, fasting plasma glucose (FPG), insulin, lipids and the urinary albumin/creatinine ratio were measured.ResultsThere were no significant differences in HbA1c (1% decrease in both groups) and FPG between groups. There was a decrease in fasting insulin in the pioglitazone group compared to an increase in the gliclazide group (p < 0.001). There were significantly greater improvements in triglycerides and HDL-cholesterol in the metformin plus pioglitazone group compared to the metformin plus gliclazide group (p < 0.001). Mean LDL-cholesterol decreased with metformin plus gliclazide and increased with metformin plus pioglitazone (p < 0.001); however, this increase was considerably less marked than that in HDL-cholesterol. The mean urinary albumin/creatinine ratio was reduced by 10% in the metformin plus pioglitazone group compared to an increase of 6% in the metformin plus gliclazide group (p = 0.027). The incidence of adverse events was comparable between groups and both combinations were well tolerated.There were no significant differences in HbA1c (1% decrease in both groups) and FPG between groups. There was a decrease in fasting insulin in the pioglitazone group compared to an increase in the gliclazide group (p < 0.001). There were significantly greater improvements in triglycerides and HDL-cholesterol in the metformin plus pioglitazone group compared to the metformin plus gliclazide group (p < 0.001). Mean LDL-cholesterol decreased with metformin plus gliclazide and increased with metformin plus pioglitazone (p < 0.001); however, this increase was considerably less marked than that in HDL-cholesterol. The mean urinary albumin/creatinine ratio was reduced by 10% in the metformin plus pioglitazone group compared to an increase of 6% in the metformin plus gliclazide group (p = 0.027). The incidence of adverse events was comparable between groups and both combinations were well tolerated.ConclusionsCompared to the established combination of metformin plus gliclazide, this study indicates potential benefits of addition of pioglitazone to metformin in terms of improvements in microalbuminuria and specific abnormalities associated with diabetic dyslipidemia. Copyright © 2004 John Wiley & Sons, Ltd.Compared to the established combination of metformin plus gliclazide, this study indicates potential benefits of addition of pioglitazone to metformin in terms of improvements in microalbuminuria and specific abnormalities associated with diabetic dyslipidemia. Copyright © 2004 John Wiley & Sons, Ltd.
International Journal of Health Sciences and Research, 2014
Type 2 diabetes mellitus is often characterized by hyperglycemia as a result of increased insulin resistance in hepatic, peripheral tissues and pancreatic β-cell dysfunction. Approximately 92% of patients with type 2 diabetes mellitus demonstrate insulin resistance; however hyperglycemia is always a consequence of insulin deficiency. This study was done on 150 patients newly diagnosed diabetes type 2 characterized by dyslipidaemia that is increased triglycerides and decreased HDL. Hypoglycemia and weight gain are common problems with oral sulfonylurea drugs. In this study two different oral hypoglycemic drugs Glibenclamide (insulin secretagogues) and Pioglitazone (insulin sensitizer) were used for treatment of patients with type 2 diabetes mellitus. The effects of these drugs on fasting and postprandial blood glucose levels, lipid profiles (TC, TG, and HDL) were studied. Two groups of newly diagnosed type 2 diabetic patients, group 1 (75 patients) were subjected to treatment with Gl...