Combination therapy using metformin or thiazolidinediones and insulin in the treatment of diabetes mellitus.

The biguanide, metformin, sensitizes the liver to the effect of insulin, suppressing hepatic glucose output. Thiazolidinediones such as rosiglitazone and pioglitazone enhance insulin-mediated glucose disposal, leading to reduced plasma insulin concentrations. These classes of drugs may also have varying beneficial effects on features of insulin resistance such as lipid levels, blood pressure and body weight.

The effect of rosiglitazone on overweight subjects with type 1 diabetes.

Objective: To evaluate the safety and effectiveness of rosiglitazone in the treatment of overweight subjects with type 1 diabetes.

Research Design And Methods: A total of 50 adult type 1 diabetic subjects with a baseline BMI > or =27 kg/m(2) were randomly assigned in a double-blind fashion to take insulin and placebo (n = 25) or insulin and rosiglitazone 4 mg twice daily (n = 25) for a period of 8 months. Insulin regimen and dosage were modified in all subjects to achieve near-normal glycemic control.

Improved glycemic control without weight gain using triple therapy in type 2 diabetes.

Objective: To evaluate the safety and effectiveness of triple therapy using insulin, metformin, and a thiazolidinedione following a course of dual therapy using insulin and metformin or insulin and a thiazolidinedione in type 2 diabetes.

Research Design And Methods: Twenty-eight type 2 diabetic subjects using insulin monotherapy (baseline HbA(lc) level 8.5%) who had been randomly assigned to insulin (INS) and metformin (MET) (INS + MET, n = 14) or INS and the thiazolidinedione troglitazone (TGZ) (INS + TGZ, n = 14) (dual therapy) for 4 months were given INS, MET, and TGZ (triple therapy: INS + MET, add TGZ; or INS + TGZ, add MET) for another 4 months.

Comparison of insulin monotherapy and combination therapy with insulin and metformin or insulin and troglitazone in type 2 diabetes.

Objective: To evaluate the safety and efficacy of treatment with insulin alone, insulin plus metformin, or insulin plus troglitazone in individuals with type 2 diabetes.

Research Design And Methods: A total of 88 type 2 diabetic subjects using insulin monotherapy (baseline HbA(lc) 8.7%) were randomly assigned to insulin alone (n = 31), insulin plus metformin (n = 27), or insulin plus troglitazone (n = 30) for 4 months.