Troglitazone Use in Insulin-Treated Type 2 Diabetic Patients

OBJECTIVE To determine the ability of troglitazone to reduce requirements for injected insulin while maintaining blood glucose levels in insulin-treated patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS This 26-week double-blind study with open-label extension included patients who had failed previous oral antidiabetic medication and took ≥30 but <150 U of insulin daily The 222 patients in the double-blind study received 200 or 400 mg troglitazone once daily or matching placebo. The primary end point was the proportion of patients meeting the target of ≥50% reduction in injected insulin and either a 15% reduction in fasting blood glucose or a blood glucose <7.8 mmol/l. Insulin dose was reduced 25% based on a study-specific algorithm whenever fasting blood glucose was reduced 5% from baseline. Also of interest were changes in insulin dose and HbA_1c. The open-label extension included 173 patients. They received 200 mg of troglitazone with optional titration to 400 mg, and insulin dose was adjusted based on investigators' standards of care. Open-label measures were change in insulin dose, HbA_1c, and fasting serum glucose (FSG).

RESULTS In the double-blind phase, 22 and 27% of the 200- and 400-mg troglitazone groups, respectively, reached target, compared with placebo (7%) (P < 0.01). Insulin dose reductions of 13 ± 3, 30 ± 3, and 41 ± 3 U were observed for placebo, 200-, and 400-mg troglitazone groups, respectively HbA_1c decreased 0.09 ± 0.14% for placebo, 0.13 ± 0.14% for 200 mg, and 0.41 ± 0.14% for 400 mg (P < 0.05) troglitazone. In the open-label extension, troglitazone treatment resulted in >50% reduction from baseline in daily insulin dose and decreases in HbA_1c of 1% and in FSG of >17%.

CONCLUSIONS Troglitazone decreases daily injected insulin dose requirements and improves glycemic control in insulin-treated patients with type 2 diabetes.