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Beneficial Effects of Triple Drug Combination of Pioglitazone with Glibenclamide and Metformin in Type 2 Diabetes Mellitus Patients on Insulin Therapy.

Abstract

Background : The thiazolidinediones are a class of antidiabetes medication that enhance the actions of

insulin in muscle, liver, and adipose tissue. Data have been lacking on their use in combination with both

sulfonylurea and metformin among patients of type 2 diabetes who are on insulin therapy secondary to

failure of routine oral hypoglycemic drugs in controlling their diabetes.

Objective: To determine the effects of pioglitazone in combination with sulphonylurea and metformin

on diabetes control in patients being treated with insulin due to secondary failure of oral hypoglycemic

agents.

Patients : One hundred and twenty-four consecutive type 2 diabetes patients (mean age, 57.13 years)

attending four centres in Mumbai, who were being treated with insulin were selected. They were

switched on to triple drug combination of glibenclamide 5 mg, metformin 500 mg and pioglitazone

15 mg along with insulin. Study participants were required to have type 2 diabetes mellitus for atleast

5 years. Patients were excluded if they had any of the following: serum creatinine concentration greater

than 1.5 mg/dl, alanine aminotransferase (ALT) level more than two times the upper limit of normal,

symptomatic angina, cardiac insufficiency or history of myocardial infarction.

Results: Pioglitazone 15 mg with glibenclamide 5 mg and metformin 500 mg, significantly decreased

hemoglobin HbA1c

level from 11.5% to 7.32% ( P < 0.001), average fasting blood glucose from 194.8 mg/

dl to 124.06 mg/dl (p < 0.01), average post-prandial blood glucose from 256.24 to 162.32 mg/dl (p <

0.01). At 6 months, 43.35% of patients did not need to be continued on insulin. The total insulin

requirement in 124 patients reduced by 71.81%. There were no significant side effects, liver enzymes

were within acceptable levels, average weight gain was 2.23 kg, significant hypoglycemia was observed in

28 patients with two requiring hospitalisation, these patients were those who did not stick to follow-up

schedules.

Conclusions : With proper patient selection, pioglitazone with glibenclamide and metformin can be

safely used in patients receiving insulin with good results.

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