Effects of early use of pioglitazone in combination with metformin in patients with newly diagnosed type 2 diabetes

Abstract

This preliminary analysis of an observational, non-randomised, open-label ongoing study has shown that early use of combination therapy at time of diagnosis or within the first 3-6 months following diagnosis with metformin plus pioglitazone in newly diagnosed type 2 diabetes results in a slower deterioration in glycaemic control than that with metformin combined with either gliclazide or repaglinide. This may be due to the beta-cell protective properties of pioglitazone. These results need to be confirmed by further studies with a more robust design and methodology.

Oral antidiabetic drugs: their properties and recommended use

“…Over a three-year follow-up period those patients treated with the metformin/pioglitazone combination showed a 0.1 per cent increase in HbA 1c per year compared with a 0.5 per cent increase seen in the other two combinations, suggesting there are beta-cell protective properties with the pioglitazone therapy. 20 This is in keeping with the ADOPT trial results mentioned above. 12 The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have proposed a treatment algorithm for type 2 diabetes mellitus (see Figure 1), 21 advocating metformin at diagnosis with lifestyle measures.…”

“…The author's preference at three to six months after diagnosis is to then move on to a metformin/pioglitazone combination where the HbA 1c is above 7 per cent, based on experience with other drug combinations followed up for three years after diagnosis (see above). 20 There is no danger of hypoglycaemia when metformin and a TZD are used in combination at such an early stage as they are both insulin sensitisers. When treating to target there is always a risk of hypoglycaemia where metformin is used in combination with an insulin secretagogue or insulin itself.…”

Safety and Efficacy of Pioglitazone/Metformin Combination Therapy in Treatment of Type 2 Diabetes: A Rationale for Earlier Use

“…(Table 2) Consideration should be clinically and mechanistically driven with combination therapy chosen based on individual need for more aggressive treatment of insulin resistance vs. need for more aggressive beta-cell and postprandial effect. Chalmers 82 has demonstrated that when started within 3 months of diagnosis, pioglitazone/ metformin was associated with a rise in A-1-C of 0.1% per year over 3 years compared to 0.5%/yr in the gliclazide/repaglinide group. The Texas diabetes board which oversees the care of a heavily ethnic and more rapidly disease progressive population has mandated initiation of combination therapy for all patients with a Hgb-A-1-C of greater than 6.5, recognizing the need for aggressive and early control in a more diffi cult patient population and the need for rapid stabilization of the disease.…”

Avoiding hypoglycaemia while achieving good glycaemic control in type 2 diabetes through optimal use of oral agent therapy

“…Evidence from both in vitro and clinical studies with the thiazolidinediones suggests that they have the potential to preserve -cell function 63 . Thiazolidinediones and to a lesser extent metformin, also appear to provide the most durable long-term glycaemic control among the different classes of oral agents 39,[64][65][66] . Evidence also suggests that DPP-4 inhibitors have the potential to preserve the -cell 67 .…”