Comparison of Effect of Pioglitazone With Metformin or Sulfonylurea (Monotherapy and Combination Therapy) on Postload Glycemia and Composite Insulin Sensitivity Index During an Oral Glucose Tolerance Test in Patients With Type 2 Diabetes

Abstract

OBJECTIVE -Pioglitazone, metformin, and gliclazide lower HbA 1c and fasting plasma glucose in patients with type 2 diabetes. We compared the effects of these three drugs, used as monotherapy and in combination, on postload glycemia and composite insulin sensitivity index (CISI) in these patients.RESEARCH DESIGN AND METHODS -Postload glycemia and CISI were analyzed for 940 patients who had oral glucose tolerance tests (OGTTs) in four multicenter, randomized, double-blind, double-dummy, parallel group clinical trials (pioglitazone versus metformin, pioglitazone versus gliclazide, pioglitazone plus sulfonylurea versus metformin plus sulfonylurea, and pioglitazone plus metformin versus gliclazide plus metformin). Plasma glucose and insulin were determined during the 3-h OGTT performed at baseline and after 1 year of therapy. Incremental area under the curve for glucose was the surrogate for postload glycemia. CISI was calculated using the formula {10,000/͌ of [(fasting glucose ϫ fasting insulin) ϫ (mean glucose ϫ mean insulin)]} during the OGTT.RESULTS -In monotherapy, pioglitazone reduced postload glycemia and enhanced CISI more than metformin and gliclazide. In combination therapy, pioglitazone plus sulfonylurea reduced postload glycemia and increased CISI more than metformin plus sulfonylurea. Pioglitazone plus metformin also decreased postload glycemia and increased CISI more than gliclazide plus metformin.CONCLUSIONS -Pioglitazone improves postload glycemia and CISI more than metformin or gliclazide when used as monotherapy or in combination therapy in patients with type 2 diabetes. Diabetes Care 28:266 -272, 2005

Efficacy of berberine in patients with type 2 diabetes mellitus

“…The effect of decreasing HbA1c was comparable to that of metformin, a widely-used oral hypoglycemic agent [9,10]. In monotherapy, berberine and metformin all improved glycemic parameters (HbA 1c , FBG and PBG).…”

X-3, a mangiferin derivative, stimulates AMP-activated protein kinase and reduces hyperglycemia and obesity in db/db mice

“…We chose Pio as a positive control, because Pio as an AMPK activator (Nawrocki et al, 2010;Zhou et al, 2001) was shown to be superior to metformin (Met) in improving postload glycemia and composite insulin sensitivity index (CISI) in patients with type 2 diabetes (Ceriello et al, 2005;Schernthaner et al, 2004). As Fig.…”

Impact of metformin versus the prandial insulin secretagogue, repaglinide, on fasting and postprandial glucose and lipid responses in non-obese patients with type 2 diabetes

“…Numerous studies have compared the effect of different antihyperglycaemic treatment regimens on postprandial glucose metabolism in patients with T2DM (14)(15)(16)(17)(18). So far, however, only relatively few among these studies included data on postprandial lipidaemia (17,(19)(20)(21)(22)(23)(24)(25)(26) and most studies included mainly obese patients with T2DM (15,16,(18)(19)(20)(21)(22)(23)26). However, among Caucasian patients with T2DM, w15-20% are not obese (27) and compared with obese patients with T2DM, non-obese patients with T2DM have a similar risk of CVD (28), but are characterized by a more deficient insulin secretion and lesser degree of insulin resistance (29).…”