Issue 152 Item 6 Combination Therapy Improves Management of Obese Diabetics

Adding rosiglitazone, to metformin, greatly enhances the management of obese type 2 diabetic patients who are inadequately controlled by metformin alone. The combination improves glycemic control, insulin sensitivity and beta-cell function to “a clinically important extent”, say researchers at GlaxoSmithKline, Collegeville, Pennsylvania and in Harlow, Essex, England, and endocrinologists in Antwerp, Belgium. They evaluated the efficacy of rosiglitazone when added to the therapy of obese diabetics taking near-maximum metformin doses of 2.5 grams daily.

The researchers reasoned that adding an agent, such as rosiglitazone, which reduced insulin resistance to the treatment of obese, insulin-resistant diabetics who were inadequately controlled by metformin might be a more rational approach than adding an insulin secretagogue.

Data involving 550 type 2 diabetics were pooled from two double-blind studies of rosiglitazone added to metformin 2.5 grams daily.

Patients were categorised according to their index baseline body mass as non-overweight (<25 kgm-2), overweight (25-30 kgm-2, ) and obese (>30 kgm-2).

Rosiglitazone significantly improved glycemia (HbA1c) and fasting plasma glucose in all three groups. The greatest effect was in the obese patients.

Improvements in Homeostasis Model Assessment estimates of insulin resistance, beta-cell function and reductions in fasting insulin were also greatest in obese patients.

Adverse events did not demonstrably differ between obese and non-obese patients. Diabetes, Obesity & Metabolism 2003;5:3:163-170

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DID YOU KNOW: A recent article reported that patients with diabetes are 1.6 times more likely than patients without diabetes to use complementary and alternative medicines. Recent surveys of patients treated in diabetes clinics indicate that 17-31% use complementary products. Jama 280:1569-1575 1998, Pract Diabetes Int 14:207-214, 1997