Issue 120 Item 10 Triple Oral Therapy Effective for Long-term Management of Type

Triple oral antidiabetic therapy is an effective long-term treatment for many patients with type 2 diabetes, who initially achieve gylcemic control with triple oral therapy. Drs. David S. Bell and Fernando Ovalle, from University of Alabama at Birmingham School of Medicine, in Birmingham, Alabama, United States, studied 35 patients with type 2 diabetes, who had been treated with a combination of sulfonylurea, metformin and a thiazolidinedione for 18 to 45 months (mean 37 months).

Twenty-six (74 percent) patients achieved good control of blood glucose levels, with a mean glycated hemoglobin (HbA1c) value of 6.9 percent, the researchers reported. In the nine other patients, treatment failed to control blood glucose levels, and insulin therapy was necessary after a mean of 30 months. Their mean HbA1c value in this group was 8.8 percent.

A search for potential predictors of treatment success or failure revealed that both groups had similar baseline characteristics, including age, duration of diabetes, weight, body mass index, HbA1c values, and stimulated C-peptide levels. None of these factors were found to correlate with response to therapy. Both groups gained similar amounts of weight during the study period (14.2 lb versus 11.6 lb, respectively; p=0.54), the investigators noted.

The only difference they observed was a significant increase in the stimulated C-peptide levels at follow-up in patients who had good glycemic control (p=0.002) compared to a nonsignificant increase in the group that failed to maintain glycemic control (p=0.46).

"Triple oral antidiabetic therapy is an effective long-term treatment for a substantial proportion of patients with type 2 diabetes, who initially achieve glycemic control with triple oral therapy, particularly those in whom production of endogenous insulin is increased when a thiazolidinedione is added," the researchers concluded.
Endocr Pract 2002; 8: 271-275