Troglitazone, an insulin action enhancer, improves metabolic control in NIDDM patients

Kumar, Sudhesh; Boulton, A. J. M.; Beck‐Nielsen, Henning; Berthezéne, F; Muggeo, Michele; Persson, Bengt; Spinas, Giatgen A.; Donoghue, Stephen; Lettis, Sally; Stewart-Long, P.

doi:10.1007/bf00418542

Cited by 225 publications

(84 citation statements)

References 33 publications

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“…These lipid changes have also been seen with other thiazolidinedione therapy [21]. Serum triglyceride concentrations, both fasting and postprandial, were unchanged by rosiglitazone treatment.…”

Section: Discussionsupporting

confidence: 55%

Rosiglitazone short-term monotherapy lowers fasting and post-prandial glucose in patients with Type II diabetes

et al. 2000

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Because insulin resistance plays a prominent part in the development of Type II diabetes [1,2], therapeutic interventions to improve insulin action are likely to be of considerable benefit in the management of the condition. The thiazolidinediones (or glitazones) are a new class of orally active drugs that reduce insulin resistance [3] and hence increase glucose uptake in skeletal muscle and adipose tissue, as well as decrease hepatic glucose production. These effects are thought to be mediated through interactions of these drugs with the gamma subtype of the peroxisome proliferator-activated receptor gamma (PPARg) [4,5].The thiazolidinediones currently marketed, or in late-phase clinical trials, include troglitazone, rosiglitazone and pioglitazone. Although these compounds share a common thiazolidine-2±4-dione structure, Diabetologia (2000) Abstract Aims/hypothesis. The short-term efficacy, safety and tolerability of rosiglitazone were compared with placebo in patients with Type II (non-insulin-dependent) diabetes mellitus in a dose-ranging study. Methods. After a 2-week placebo run-in phase, 303 patients were randomly assigned to 8 weeks of treatment with twice-daily placebo or 2, 4 or 6 mg of rosiglitazone. Results. All rosiglitazone doses significantly reduced fasting plasma glucose compared with baseline. All rosiglitazone treatment groups showed significantly reduced peak postprandial glucose concentrations compared with baseline (p < 0.001) and with placebo (p < 0.0001) and reduced postprandial glucose excursion, without an increase in the area under the postprandial insulin concentration-time curve. Rosiglitazone at 4 and 6 mg twice daily prevented the increase in HbA 1 c observed in the placebo group. C peptide and serum insulin concentrations were significantly reduced from baseline in all rosiglitazone treatment groups. In all rosiglitazone treatment groups, nonesterified fatty acids decreased significantly (p < 0.0001) and triglycerides did not change. Although total LDL and HDL cholesterol increased significantly in the rosiglitazone treatment groups, total cholesterol/HDL ratios did not change significantly. The proportion of patients with one or more adverse event was similar in all four treatment groups. No patient showed evidence of hepatotoxicity. Conclusion/interpretation. Rosiglitazone given twice daily significantly reduced fasting and postprandial glucose concentrations, C peptide, insulin and nonesterified fatty acids in Type II diabetic patients. The glucose-lowering effect of the 4-mg twice-daily dose of rosiglitazone was similar to that of 6-mg twice daily, suggesting that 4 mg twice daily should be the maximum clinical dose. [Diabetologia (2000) 43: 278±284]

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Section: Discussionsupporting

confidence: 55%

Rosiglitazone short-term monotherapy lowers fasting and post-prandial glucose in patients with Type II diabetes

et al. 2000

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“…A candidate test should score high in analysis of test performance and be simple, safe and cheap. Two large studies illustrate the application of HOMA for assessing for the natural course of diabetes [52] or the response to pharmacological intervention [11].…”

Section: Discussionmentioning

confidence: 99%

Comparison of insulin sensitivity tests across a range of glucose tolerance from normal to diabetes

et al. 1999

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Impaired glucose tolerance (IGT) and Type II (noninsulin-dependent) diabetes mellitus result from different contributions of deficient insulin secretion and impaired insulin sensitivity [1±8]. Routine quantification of these abnormalities is rarely done as simple, user friendly methods have not been validated or received general approval [9,10]. The choice of therapy might depend on the causative pathophysiology in a patient and, with the prospect of insulin-sensitising drugs as well as life-style changes to improve insulin sensitivity, routine assessment of insulin sensitivity might become more appropriate than at present [11, Diabetologia (1999) AbstractAims/hypothesis. Adequate comparison of the relative performance of insulin sensitivity tests is not yet available. We compared the discrimination of four insulin sensitivity tests, commonly used in vivo, across a range of glucose tolerance. Methods. Normal (n = 7), impaired glucose tolerant (n = 8) and Type II (non-insulin-dependent) diabetic subjects (n = 9) had in random order two tests from the following: frequently sampled insulin-modified intravenous glucose tolerance test (FSIVGTT-MinMod); homeostasis model assessment (HOMA) and 2-h continuous infusion of glucose with model assessment (CIGMA) with immunoreactive or specific insulin; short insulin tolerance tests (ITT). The discriminatory power of tests was assessed by the ratio of the within-subject standard deviation to the underlying between-subject standard deviation (discriminant ratio ± DR). The degree to which tests measured the same variable was assessed by comparing rank correlation with the maximum expected correlation given the imprecision of the tests. The unbiased lines of equivalence taking into account the precision of tests were constructed.Results. Reciprocal fasting plasma insulin (FPI ±1 ), HOMA %S and 2-h CIGMA %S, had similar DRs with ITT being less informative. The FSIVGTT-MinMod analysis was able to assess 13 out of 24 subjects and had a performance similar to ITT. Using specific rather than immunoreactive insulin for HOMA-CIG-MA did not improve the DR. Reciprocal fasting plasma insulin FPI ±1 , HOMA %S, 2-h CIGMA %S and S I FSIVGTT intercorrelated more than 90 % of the expected rank correlation given the imprecision of the tests, but ITT gave only limited correlation. Conclusion/interpretation. The HOMA-CIGMA test with immunoreactive insulin provides similar information in distinguishing insulin sensitivity between subjects with normal glucose tolerance, those with impaired glucose tolerance and those with Type II diabetes as does FSIVGTT, whereas ITT is less informative. [Diabetologia (1999) 42: 678±687]

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“…The latter patients may be at risk of pregnancy. 116,117 Troglitazone is usually started at a dose of 200 mg/d, and over 2 to 4 weeks can be titrated to 400 mg/d. The maximal dose is 600 mg/d.…”

Section: Thiazolidinedionesmentioning

confidence: 99%

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

et al. 1997

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PURPOSE:To summarize current knowledge of interventions that should improve the care of patients with type II diabetes mellitus. Interventions lie within the realms of prevention, screening, and treatment, all of which are focused on office practice. METHODS:Review of the literature by a multidisciplinary team involved in the care of patients with diabetes, followed by synthesis of the literature into a clinical care guideline. Literature was identified through consultation with experts and a focused MEDLINE search. MAIN RESULTS:An algorithm-based guideline for screening and treatment of the complications of diabetes was developed. The emphasis is on prevention of atherosclerotic disease, and prevention, screening, and early treatment of microvascular disease. Implementation of these practices has the potential to significantly improve quality of life and increase life expectancy in patients with type II diabetes mellitus. ype II diabetes is a common condition, affecting 2% to 3% of the adult population, and up to 20% to 25% of the elderly population. 1 Type II diabetes typically occurs in patients who are over 30 years old and weigh more than 120% of ideal body weight, and accounts for 90% of all cases of diabetes mellitus diagnosed in the United States. 1 Minorities have a prevalence of type II diabetes mellitus that is 2 to 6 times greater than that of white persons. The morbidity and mortality are higher for minorities than for white persons, and the rate is increasing. 2 The reasons for this disparity remain unclear, but could include differences in disease severity, comorbidities, or access to care.Diabetes has significant associated morbidity. Prevention and treatment of the complications of diabetes mellitus have the potential to improve quality of life and increase life expectancy. 3 The rate of cardiovascular disease is markedly elevated among patients with type II diabetes, leading to an increased mortality rate compared with the general population. 4,5 In addition, microvascular complications, which include retinopathy, nephropathy, and neuropathy, can progress to end-stage outcomes such as blindness, end-stage renal disease (ESRD), and amputation. Screening and early treatment for diabetic complications have been shown to be effective in reducing the incidence of end-stage disease 6,7 ; despite this evidence, implementation rates of recommended interventions are low. 8 This frequently leads to ineffective or delayed treatment of complications. 9-11 Because optimal diabetes care is a complex process, we developed a clinical care guideline to help busy clinicians incorporate prevention, screening, and treatment recommendations into practice. METHODSA multidisciplinary team was assembled to develop an evidence-based guideline for the prevention and treatment of complications of type II diabetes. The multidisciplinary team included members from endocrinology, family practice, general internal medicine, obstetrics-gyncecology, nursing, and postgraduate medicine departments. Team members have an interest ...

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Troglitazone, an insulin action enhancer, improves metabolic control in NIDDM patients

Cited by 225 publications

References 33 publications

Rosiglitazone short-term monotherapy lowers fasting and post-prandial glucose in patients with Type II diabetes

Rosiglitazone short-term monotherapy lowers fasting and post-prandial glucose in patients with Type II diabetes

Comparison of insulin sensitivity tests across a range of glucose tolerance from normal to diabetes

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

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