Advertisement

Acta Diabetologica

, Volume 44, Issue 4, pp 187–192 | Cite as

Comparison of insulin monotherapy and combination therapy with insulin and metformin or insulin and rosiglitazone or insulin and acarbose in type 2 diabetes

  • Hamiyet Yilmaz
  • Alptekin GursoyEmail author
  • Mustafa Sahin
  • Nilgun Guvener Demirag
Original Article

Abstract

The aim of this study was to compare the efficacy of treatment with insulin alone, insulin plus acarbose, insulin plus metformin, or insulin plus rosiglitazone in type 2 diabetic subjects who were previously on insulin monotherapy, and to evaluate the effects of these treatments on cardiovascular risk factors including lipid profile, C-reactive protein (CRP) and fibrinogen. Sixty-six poorly controlled type 2 diabetic patients on insulin monotherapy were involved. They were randomized to insulin alone, insulin plus acarbose, insulin plus metformin, or insulin plus rosiglitazone groups for 6 months period. Mean fasting and postprandial glucose values as well as HbA1c levels significantly decreased in all groups. The greatest improvement in HbA1c was observed in insulin plus rosiglitazone (2.4%) and in insulin plus metformin (2%) groups. Daily total insulin dose was increased to 12.7 units/day in insulin alone group, decreased to 4.7 units/day in insulin plus rosiglitazone group, to 4.2 units/day in insulin plus metformin group, and to 2.7 units/day in insulin plus acarbose group. Least weight gain occurred in insulin plus metformin group (1.4 kg) and greatest weight gain occurred in insulin plus rosiglitazone group (4.6 kg). No significant change in lipid levels—except serum triglycerides—was observed in any groups. CRP and fibrinogen levels decreased in all groups, but the decrease in fibrinogen level was significantly greater in insulin plus rosiglitazone group. All groups were comparable in hypoglycemic episodes. No serious adverse event was noted in any group.

Keywords

Type 2 diabetes mellitus Combination Insulin Acarbose Metformin Rosiglitazone 

References

  1. 1.
    American Diabetes Association (2005) Standards of medical care in diabetes. Diabetes Care 28(Suppl 1):4–36CrossRefGoogle Scholar
  2. 2.
    Bailey CJ (2005) Treating insulin resistance in type 2 diabetes with metformin and thiazolidinediones. Diabetes Obes Metab 7:675–691PubMedCrossRefGoogle Scholar
  3. 3.
    Manninen V, Tenkanen L, Koskinen P, Huttunen JK, Manttari M, Heinonen OP, Frick MH (1992) Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki heart study. Implications for treatment. Circulation 85:37–45PubMedGoogle Scholar
  4. 4.
    Md Isa SH, Najihah I, Nazaimoon WM, Kamarudin NA, Umar NA, Mat NH, Khalid BA (2006) Improvement in C-reactive protein and advanced glycosylation end-products in poorly controlled diabetics is independent of glucose control. Diabetes Res Clin Pract 72:48–52PubMedCrossRefGoogle Scholar
  5. 5.
    Cavaghan MK, Ehrmann DA, Byrne MM, Polonsky KS (1997) Treatment with the oral antidiabetic agent troglitazone improves beta cell responses to glucose in subjects with impaired glucose tolerance. J Clin Invest 100:530–537PubMedCrossRefGoogle Scholar
  6. 6.
    Chiasson JL, Josse RG, Leiter LA, Mihic M, Nathan DM, Palmason C, Cohen RM, Wolever TM (1996) The effect of acarbose on insulin sensitivity in subjects with impaired glucose tolerance. Diabetes Care 19:1190–1193PubMedCrossRefGoogle Scholar
  7. 7.
    Chu NV, Kong AP, Kim DD, Armstrong D, Baxi S, Deutsch R, Caulfield M, Mudaliar SR, Reitz R, Henry RR, Reaven PD (2002) Differential effects of metformin and troglitazone on cardiovascular risk factors in patients with type 2 diabetes. Diabetes Care 25:542–549PubMedCrossRefGoogle Scholar
  8. 8.
    Finegood DT, McArthur MD, Kojwang D, Thomas MJ, Topp BG, Leonard T, Buckingham RE (2001) Beta-cell mass dynamics in Zucker diabetic fatty rats. Rosiglitazone prevents the rise in net cell death. Diabetes 50:1021–1029PubMedCrossRefGoogle Scholar
  9. 9.
    Hsueh WA, Jackson S, Law RE (2001) Control of vascular cell proliferation and migration by PPAR-gamma: a new approach to the macrovascular complications of diabetes. Diabetes Care 24:392–397PubMedCrossRefGoogle Scholar
  10. 10.
    Minamikawa J, Tanaka S, Yamauchi M, Inoue D, Koshiyama H (1998) Potent inhibitory effect of troglitazone on carotid arterial wall thickness in type 2 diabetes. J Clin Endocrinol Metab 83:1818–1820PubMedCrossRefGoogle Scholar
  11. 11.
    Sidhu JS, Cowan D, Kaski JC (2003) The effects of rosiglitazone, a peroxisome proliferator-activated receptor-gamma agonist, on markers of endothelial cell activation, C-reactive protein, and fibrinogen levels in non-diabetic coronary artery disease patients. J Am Coll Cardiol 42:1757–1763PubMedCrossRefGoogle Scholar
  12. 12.
    Sung BH, Izzo JL Jr, Dandona P, Wilson MF (1999) Vasodilatory effects of troglitazone improve blood pressure at rest and during mental stress in type 2 diabetes mellitus. Hypertension 34:83–88PubMedGoogle Scholar
  13. 13.
    Delorme S, Chiasson JL (2005) Acarbose in the prevention of cardiovascular disease in subjects with impaired glucose tolerance and type 2 diabetes mellitus. Curr Opin Pharmacol 5:184–189PubMedCrossRefGoogle Scholar
  14. 14.
    Guvener N, Gedik O (1999) Effects of combination of insulin and acarbose compared with insulin and gliclazide in type 2 diabetic patients. Acta Diabetol 36:93–97PubMedCrossRefGoogle Scholar
  15. 15.
    Zimmerman BR (1992) Preventing long term complications. Implications for combination therapy with acarbose. Drugs 44(Suppl 3):54–60PubMedCrossRefGoogle Scholar
  16. 16.
    Huang A, Raskin P (2005) Thiazolidinediones and insulin: rationale for use and role of combination therapy in type 2 diabetes mellitus. Treat Endocrinol 4:205–220PubMedCrossRefGoogle Scholar
  17. 17.
    Hermanns N, Burkert A, Haak T (2004) The addition of acarbose to insulin lispro reduces acute glycaemic responses in patients with type-2 diabetes. Exp Clin Endocrinol Diabetes 112:310–314PubMedCrossRefGoogle Scholar
  18. 18.
    Strowig SM, Aviles-Santa ML, Raskin P (2002) Comparison of insulin monotherapy and combination therapy with insulin and metformin or insulin and troglitazone in type 2 diabetes. Diabetes Care 25:1691–1698PubMedCrossRefGoogle Scholar
  19. 19.
    Sangiorgio L, Attardo T, Condorelli L, Lunetta M (2000) Effects of the treatment with acarbose in elderly overweight type 2 diabetic patients in poor glycemic control with oral hypoglycemic agents or insulin. Arch Gerontol Geriatr 31:27–34PubMedCrossRefGoogle Scholar
  20. 20.
    Standl E, Baumgartl HJ, Fuchtenbusch M, Stemplinger J (1999) Effect of acarbose on additional insulin therapy in type 2 diabetic patients with late failure of sulphonylurea therapy. Diabetes Obes Metab 1:215–220PubMedCrossRefGoogle Scholar
  21. 21.
    Wulffele MG, Kooy A, Lehert P, Bets D, Ogterop JC, Borger van der Burg B, Donker AJ, Stehouwer CD (2002) Combination of insulin and metformin in the treatment of type 2 diabetes. Diabetes Care 25:2133–2140PubMedCrossRefGoogle Scholar
  22. 22.
    Yu JG, Kruszynska YT, Mulford MI, Olefsky JM (1999) A comparison of troglitazone and metformin on insulin requirements in euglycemic intensively insulin-treated type 2 diabetic patients. Diabetes 48:2414–2421PubMedCrossRefGoogle Scholar
  23. 23.
    Wellington K (2005) Rosiglitazone/metformin. Drugs 65:1581–1592PubMedCrossRefGoogle Scholar
  24. 24.
    Kobayashi J, Nagashima I, Hikita M, Bujo H, Takahashi K, Otabe M, Morisaki N, Saito Y (1999) Effect of troglitazone on plasma lipid metabolism and lipoprotein lipase. Br J Clin Pharmacol 47:433–439PubMedCrossRefGoogle Scholar
  25. 25.
    Schwartz S, Raskin P, Fonseca V, Graveline JF (1998) Effect of troglitazone in insulin-treated patients with type II diabetes mellitus. Troglitazone and exogenous insulin study group. N Engl J Med 338:861–866PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Hamiyet Yilmaz
    • 1
  • Alptekin Gursoy
    • 1
    Email author
  • Mustafa Sahin
    • 1
  • Nilgun Guvener Demirag
    • 1
  1. 1.Department of Endocrinology and Metabolic DiseasesBaskent University Faculty of MedicineBahcelievler/AnkaraTurkey

Personalised recommendations