Primary, secondary, tertiary, and quaternary treatment with troglitazone in type 2 diabetes mellitus in an outpatient clinical practice.
OBJECTIVE
To assess the value of troglitazone in various combinations of therapy with sulfonylureas, biguanides, and insulin, including triple oral agent therapy with and without insulin, in an outpatient clinical practice.


METHODS
We compiled results in our first 207 patients with type 2 diabetes treated for 1 year with troglitazone. In eight study groups, troglitazone was added to the following prior regimens: (1) diet alone, (2) sulfonylurea, (3) metformin, (4) sulfonylurea and metformin, (5) insulin, (6) insulin and sulfonylurea, (7) insulin and metformin, and (8) insulin, sulfonylurea, and metformin. Glycosylated hemoglobin, fasting plasma glucose, hemoglobin, weight, and insulin dose were recorded every 3 months for 1 year and are reported.


RESULTS
The glycosylated hemoglobin decreased in all study groups during the 1-year period. With the addition of troglitazone, it declined from 8.0% to 6.0% in the diet-only treatment group, from 8.9% to 7.3% in the sulfonylurea group, from 8.4% to 7.2% in the metformin group, and from 8.6% to 7.5% in the group treated with sulfonylurea and metformin. For the groups receiving insulin, glycosylated hemoglobin decreased in conjunction with a significant decline in insulin dose. The dose of insulin was reduced from a baseline of 62 to 41 U per patient in the insulin-only treatment group, from 36 to 12 U per patient in the group treated with insulin and sulfonylurea, and from 28 to 11 U per patient in the group treated with insulin and metformin. In the group treated with insulin, sulfonylurea, and metformin, the dose of insulin was decreased from 36 to 13 U.


CONCLUSIONS
From our data in more than 200 patients with type 2 diabetes, who participated in a 1-year follow-up in an outpatient clinical practice, we found that troglitazone improved glycemic control in each study group and also decreased the insulin dose in the insulin-requiring patients. Troglitazone improves glycemic control as a primary, secondary, tertiary, or even quaternary therapy in patients with type 2 diabetes.
Hershon
K S
KS
North Shore Diabetes and Endocrine Associates, New Hyde Park, New York, USA.
Hershon
P M
PM
D000368:Aged; D002839:Chromans / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D010045:Outpatients; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D013844:Thiazoles / Q000009:adverse effects / Q000627:therapeutic use*; D045162:Thiazolidinediones; D000077288:Troglitazone
D002839:Chromans; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D013453:Sulfonylurea Compounds; D013844:Thiazoles; D045162:Thiazolidinediones; D000077288:Troglitazone