Comparison of metformin, gliclazide MR and rosiglitazone in monotherapy and in combination for type 2 diabetes

Abstract

Objective: To compare the efficacy and tolerability of metformin, rosiglitazone and gliclazide MR as monotherapy and in combination in the treatment of type 2 diabetes. Subjects and methods: 250 patients treated with oral antidiabetic agents for at least 24 weeks in monotherapy or in combination therapy were included in this retrospective study. Results: As monotherapy the reduction of fasting plasma glucose (FPG), postprandial glycemia (PPG) and HbA1c was similar with the three drugs after 24 weeks. Among patients on combination therapy, the reduction in HbA1c, FPG and PPG was significantly lower with rosiglitazone plus metformin, as compared to metformin plus gliclazide MR or gliclazide MR plus rosiglitazone. Patients treated with rosiglitazone achieved less favorable changes in lipid profile. Conclusion: In monotherapy all drugs were equally effective in improving glycemic control, whereas the combination of metformin plus gliclazide MR provided the best results concerning the improvement of both, glycemic control and lipid profile. Arq Bras Endocrinol Metab. 2010;54(3):311-8 Keywords Metformin; glicazide MR; rosiglitazone RESUMO Objetivo: Comparar a eficácia e a tolerabilidade da metformina, rosiglitazona e gliclazida MR em monoterapia ou em combinação no tratamento do diabetes tipo 2. Sujeitos e métodos: 250 pacientes tratados com antidiabéticos orais por pelo menos 24 semanas, em monoterapia ou em terapia combinada, foram incluídos neste estudo retrospectivo. Resultados: Como monoterapia, a redução da glicemia de jejum (GJ), glicemia pós-prandial (GPP) e HbA1c foi similar com as três drogas, após 24 semanas. Entre os pacientes em terapia combinada, a redução da HbA1c, GJ e GPP foi significativamente menor com rosiglitazona e metformina, em comparação com metformina e gliclazida MR ou gliclazida MR mais rosiglitazona. Os pacientes tratados com rosiglitazona obtiveram mudanças menos favoráveis no perfil lipídico. Conclusão: Em monoterapia todos os medicamentos foram igualmente eficazes na melhora do controle glicêmico, enquanto a combinação de metformina e gliclazida MR proporcionou os melhores resultados relativos à melhoria de ambos, controle glicêmico e perfil lipídico. Arq Bras Endocrinol Metab. 2010;54(3):311-8

Avaliação da qualidade de vida, perda de peso e comorbidades de pacientes submetidos à cirurgia bariátrica

“…Patients with a BMI≥40kg/m 2 are considered to be severely obese and have an even greater risk of presenting comorbidities related to excessive weight 2 . Among the cases of diabetes, 80 to 90% are type II and usually affect obese patients and over 40 years of age 3 . More than 80% of these patients also have metabolic syndrome (dyslipidemia, abdominal obesity, impaired glucose tolerance or diabetes and hypertension), leading to a high cardiovascular risk 3,4 .…”

“…Among the cases of diabetes, 80 to 90% are type II and usually affect obese patients and over 40 years of age 3 . More than 80% of these patients also have metabolic syndrome (dyslipidemia, abdominal obesity, impaired glucose tolerance or diabetes and hypertension), leading to a high cardiovascular risk 3,4 . In addition, there is an association between obesity and the onset of various types of cancer 5 .…”

The Place of Sulfonylureas in the Evolving Landscape of Combination Therapy

“…SUs have demonstrated significant reductions in HbA1c and fasting plasma glucose (FPG) from baseline when administered as monotherapy [14][15][16], as well as dual therapy in combination with metformin, an alpha-glucosidase inhibitor (AGI), a GLP-1RA or basal insulin [15,[17][18][19], and as triple therapy in combination with metformin and either a DPP-4 inhibitor or SGLT2 inhibitor [20,21]. With regard to triple therapy, the STRATEGY study was a unique study of SUs, metformin and a DPP-4 inhibitor conducted in China [21].…”

“…The percentage of patients on target (i.e., HbA1c B 7%) ranged from 46.7 to 72% with SU monotherapy and approximately 40% with SUbased dual and triple therapies [15,16,[19][20][21][22]. Furthermore, results of the EasyDIA study revealed that uptitration of the SU dosage (between 30 and 120 mg per day) was associated with improved glycemic control, with dose-related significant improvements from baseline (all p \ 0.001) observed in mean levels of HbA1c and FPG after 6 months of gliclazide modified release (MR) [23].…”

Effectiveness of adding vildagliptin to the treatment of diabetic patients nonresponsive to the combination of metformin and a sulphonylurea

“…The three main options among oral glucose-lowering drugs are metformin, sulphonylureas and thiazolidinediones (TZDs) (7)(8)(9)(10). More recently, DPP-4 inhibitors, such as vildagliptin, sitagliptin and saxagliptin, became commercially available (11)(12)(13).…”