The effect of pioglitazone as add-on therapy to metformin or sulphonylurea compared to a fixed-dose combination of metformin and glibenclamide on diabetic dyslipidaemia

Comaschi, Marco; Corsi, A.; Pietro, Caterina Di; Bellatreccia, A.; Mariz, Segundo

doi:10.1016/j.numecd.2007.04.003

Cited by 14 publications

(9 citation statements)

References 26 publications

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“…The increase of HDL cholesterol over the baseline in the PIO groups (8.3% and 9.2%) shown in the present study was comparable to that observed in RCTs and significantly greater than the small increase in the SU þ MET group 22,24,[37][38][39] . The effect in the SU þ MET group is in contrast to the findings of a similar study where, in patients taking glibenclamide þ MET, HDL cholesterol decreased by 0.09 mmol/L (3.5 mg%) at six months 40 . No explanation can be offered for this difference.…”

Section: Discussioncontrasting

confidence: 99%

Study comparing the effect of pioglitazone in combination with either metformin or sulphonylureas on lipid profile and glycaemic control in patients with type 2 diabetes (ECLA)

Karamanos

Thanopoulou

Drossinos³

et al. 2010

Current Medical Research and Opinion

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Section: Discussioncontrasting

confidence: 99%

Study comparing the effect of pioglitazone in combination with either metformin or sulphonylureas on lipid profile and glycaemic control in patients with type 2 diabetes (ECLA)

Karamanos

Thanopoulou

Drossinos³

et al. 2010

Current Medical Research and Opinion

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“…106,107,111,118 In 2 RCTs, HDL-C increased in metformin plus pioglitazone arms and decreased in metformin plus sulfonylurea arms. 109,119 The between-group differences were 5.1 mg per dL (P < 0.001) and 5.8 mg per dL (P < 0.001), respectively.…”

Section: Comparative Effects Of Combination Therapies On Hypoglycemiamentioning

confidence: 95%

“…For direct comparisons of various combination therapies, the incidence of hypoglycemia was lower for metformin plus thiazolidinediones compared with other metformin combinations or compared with the thiazolidinediones plus sulfonylureas. [107][108][109]111,119,123,124 Two small studies found no significant differences in hypoglycemia for metformin combined with thiazolidinediones compared with metformin combined with GLP-1 agonists or DPP-4 inhibitors, respectively. 113,125 A small study with low-grade evidence found that the addition of insulin glargine to metformin was associated more frequent hypoglycemia (defined as fasting blood glucose < 3.3 mmol per L [59.4 mg per dL]) but not severe hypoglycemia, compared with the addition of the injectable GLP-1 agonist exenatide added to metformin.…”

Section: Comparative Effects Of Combination Therapies On Hypoglycemiamentioning

confidence: 99%

AHRQ’s Comparative Effectiveness Research on Oral Medications for Type 2 Diabetes: A Summary of the Key Findings

Bennett¹,

Balfe²,

Faysal³

2012

JMCP

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Type 2 diabetes mellitus is a major public health burden. Since the 2007 AHRQ systematic review of oral medications for type 2 diabetes, the FDA has approved several new drug classes. Therefore, in 2011, the original systematic review was updated with comparisons including the newer oral diabetes medications. The updated report expands beyond the scope of the original 2007 review by including comparisons of 2-drug combinations and the addition of more head-to-head comparisons, as well as additional adverse outcomes. A high strength of evidence showed that most medications were similarly efficacious at lowering hemoglobin A1c by about 1 absolute percentage point compared with baseline values. The addition of most oral medications to initial monotherapy further improved glycemiccontrol by lowering A1c by another 1 percentage point. The only exception was the DPP-4 inhibitor class, which did not lower A1c to the same extent as metformin when used as monotherapy. Overall, metformin was found to have a more favorable effect on body weight when compared with other medications. Two-drug combinations compared with each other demonstrated similar reductions in A1c levels. Metformin decreased low-density lipoprotein cholesterol (LDL-C) relative to pioglitazone, sulfonylureas,and DPP-4 inhibitors. Sulfonylureas had a 4-fold higher risk of mild-to-moderate hypoglycemia compared with metformin alone, and, in combination with metformin, had more than a 5-fold increased risk compared with metformin plus a thiazolidinedione. Thiazolidinediones had an increased risk of congestive heart failure relative to sulfonylureas, and an increased risk for bone fractures relative to metformin. Diarrhea occurred more often for metformin users compared with thiazolidinedione users. Although the long-term risks and benefits of diabetes medications remain unclear, the evidence supports the use of metformin as a first-line agent.

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“…Interestingly, both thiazolidinediones have been shown to increase LDL particle size and decrease LDL oxidation -- conditions that impair atherosclerosis (pioglitazone more so than rosiglitazone) [64]. Pioglitazone has also been reported to improve HDL-C and TG parameters when used as an add-on therapy in patients with type 2 diabetes who are already receiving metformin or sulfonylurea therapy [65,66] and is more effective in improving lipid and apolipoprotein levels than rosiglitazone plus sulfonylurea, in addition to ongoing statin therapy [67]. Although the use of sulfonylurea monotherapy has not been associated with significant changes in the lipid profile, the addition of acarbose to sulfonylurea therapy not only improves glycemic control, but also provides improvements in lipid parameters, particularly TG levels [68].…”

Section: Improving Dyslipidemia In Patients With Type 2 Diabetesmentioning

confidence: 99%

Treatment of dyslipidemia in patients with type 2 diabetes

Vijayaraghavan

2010

Lipids Health Dis

106

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Type 2 diabetes is associated with significant cardiovascular morbidity and mortality. Although low-density lipoprotein cholesterol levels may be normal in patients with type 2 diabetes, insulin resistance drives a number of changes in lipid metabolism and lipoprotein composition that render low-density lipoprotein cholesterol and other lipoproteins more pathogenic than species found in patients without type 2 diabetes. Dyslipidemia, which affects almost 50% of patients with type 2 diabetes, is a cardiovascular risk factor characterized by elevated triglyceride levels, low high-density lipoprotein cholesterol levels, and a preponderance of small, dense, low-density lipoprotein particles. Early, aggressive pharmacological management is advocated to reduce low-density lipoprotein cholesterol levels, regardless of baseline levels. A number of lipid-lowering agents, including statins, fibrates, niacin, and bile acid sequestrants, are available to target normalization of the entire lipid profile. Despite use of combination and high-dose lipid-lowering agents, many patients with type 2 diabetes do not achieve lipid targets. This review outlines the characteristics and prevalence of dyslipidemia in patients with type 2 diabetes and discusses strategies that may reduce the risk of cardiovascular disease in this population.

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The effect of pioglitazone as add-on therapy to metformin or sulphonylurea compared to a fixed-dose combination of metformin and glibenclamide on diabetic dyslipidaemia

Cited by 14 publications

References 26 publications

Study comparing the effect of pioglitazone in combination with either metformin or sulphonylureas on lipid profile and glycaemic control in patients with type 2 diabetes (ECLA)

Study comparing the effect of pioglitazone in combination with either metformin or sulphonylureas on lipid profile and glycaemic control in patients with type 2 diabetes (ECLA)

AHRQ’s Comparative Effectiveness Research on Oral Medications for Type 2 Diabetes: A Summary of the Key Findings

Treatment of dyslipidemia in patients with type 2 diabetes

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