HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Strowig, S. M. Articles by Raskin, P. Search for Related Content PubMed PubMed Citation Articles by Strowig, S. M. Articles by Raskin, P. Social Bookmarking                What's this?

Comparison of Insulin Monotherapy and Combination Therapy With Insulin and Metformin or Insulin and Troglitazone in Type 2 Diabetes

From the University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

OBJECTIVE—To evaluate the safety and efficacy of treatment with insulin alone, insulin plus metformin, or insulin plus troglitazone in individuals with type 2 diabetes.

RESEARCH DESIGN AND METHODS—A total of 88 type 2 diabetic subjects using insulin monotherapy (baseline HbA_lc 8.7%) were randomly assigned to insulin alone (n = 31), insulin plus metformin (n = 27), or insulin plus troglitazone (n = 30) for 4 months. The insulin dose was increased only in the insulin group. Metformin was titrated to a maximum dose of 2,000 mg and troglitazone to 600 mg.

RESULTS—HbA_lc levels decreased in all groups, the lowest level occurring in the insulin plus troglitazone group (insulin alone to 7.0%, insulin plus metformin to 7.1%, and insulin plus troglitazone to 6.4%, P < 0.0001). The dose of insulin increased by 55 units/day in the insulin alone group (P < 0.0001) and decreased by 1.4 units/day in the insulin plus metformin group and 12.8 units/day in the insulin plus troglitazone group (insulin plus metformin versus insulin plus troglitazone, P = 0.004). Body weight increased by 0.5 kg in the insulin plus metformin group, whereas the other two groups gained 4.4 kg (P < 0.0001 vs. baseline). Triglyceride and VLDL triglyceride levels significantly improved only in the insulin plus troglitazone group. Subjects taking metformin experienced significantly more gastrointestinal side effects and less hypoglycemia.

CONCLUSIONS—Aggressive insulin therapy significantly improved glycemic control in type 2 diabetic subjects to levels comparable with those achieved by adding metformin to insulin therapy. Troglitazone was the most effective in lowering HbA_lc, total daily insulin dose, and triglyceride levels. However, treatment with insulin plus metformin was advantageous in avoiding weight gain and hypoglycemia.

Abbreviations: ALT, alanine aminotransferase • AST, aspartate aminotransferase • DCCT, Diabetes Control and Complications Trial • UKPDS, U.K. Prospective Diabetes Study

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				P. Hollander, D. Yu, and H. S. Chou Low-Dose Rosiglitazone in Patients With Insulin-Requiring Type 2 Diabetes Arch Intern Med, June 25, 2007; 167(12): 1284 - 1290. [Abstract] [Full Text] [PDF]

				H. Koga, S. Sugiyama, K. Kugiyama, H. Fukushima, K. Watanabe, T. Sakamoto, M. Yoshimura, H. Jinnouchi, and H. Ogawa Elevated levels of remnant lipoproteins are associated with plasma platelet microparticles in patients with type-2 diabetes mellitus without obstructive coronary artery disease Eur. Heart J., April 1, 2006; 27(7): 817 - 823. [Abstract] [Full Text] [PDF]

				S. M. Strowig and P. Raskin The Effect of Rosiglitazone on Overweight Subjects With Type 1 Diabetes: Response to Orchard Diabetes Care, March 1, 2006; 29(3): 747 - 747. [Full Text] [PDF]

				M. C. Riddle and D. J. Drucker Emerging Therapies Mimicking the Effects of Amylin and Glucagon-Like Peptide 1 Diabetes Care, February 1, 2006; 29(2): 435 - 449. [Full Text] [PDF]

				J. Meece Dispelling Myths and Removing Barriers About Insulin in Type 2 Diabetes The Diabetes Educator, January 1, 2006; 32(1): 9S - 18S. [Full Text] [PDF]

				S. M. Strowig and P. Raskin The Effect of Rosiglitazone on Overweight Subjects With Type 1 Diabetes Diabetes Care, July 1, 2005; 28(7): 1562 - 1567. [Abstract] [Full Text] [PDF]

				S. M. Strowig, M. L. Aviles-Santa, and P. Raskin Improved Glycemic Control Without Weight Gain Using Triple Therapy in Type 2 Diabetes Diabetes Care, July 1, 2004; 27(7): 1577 - 1583. [Abstract] [Full Text] [PDF]

				C. Beebe Body Weight Issues in Preventing and Treating Type 2 Diabetes Diabetes Spectr, October 1, 2003; 16(4): 261 - 266. [Full Text] [PDF]

				D. E. DeWitt and I. B. Hirsch Outpatient Insulin Therapy in Type 1 and Type 2 Diabetes Mellitus: Scientific Review JAMA, May 7, 2003; 289(17): 2254 - 2264. [Abstract] [Full Text] [PDF]

				I. Pavo, G. Jermendy, T. T. Varkonyi, Z. Kerenyi, A. Gyimesi, S. Shoustov, M. Shestakova, M. Herz, D. Johns, B. J. Schluchter, et al. Effect of Pioglitazone Compared with Metformin on Glycemic Control and Indicators of Insulin Sensitivity in Recently Diagnosed Patients with Type 2 Diabetes J. Clin. Endocrinol. Metab., April 1, 2003; 88(4): 1637 - 1645. [Abstract] [Full Text] [PDF]