title: Short-term continuous subcutaneous insulin infusion combined with insulin sensitizers rosiglitazone, metformin, or antioxidant α-lipoic acid in patients with newly diagnosed type 2 diabetes mellitus.
abstract: BACKGROUND
  Short-term continuous subcutaneous insulin infusion (CSII) in patients with newly diagnosed type 2 diabetes has been proved effective in improving metabolic control and β-cell function, thus inducing long-term drug-free remission. A randomized controlled trial was conducted to investigate whether CSII in combination with rosiglitazone, metformin, or α-lipoic acid separately brings about extra benefits.
  
  
  METHODS
  One hundred sixty patients with newly diagnosed type 2 diabetes were randomized to one of four treatment groups: CSII alone, CSII in combination with rosiglitazone or metformin for 3 months, or CSII with α-lipoic acid intravenous infusion for 2 weeks. Duration of CSII treatment was identical in the four groups. Glucose and lipid profiles, homeostasis model assessment (HOMA) indices, acute insulin response (AIR), intramyocellular lipid (IMCL) level, and malondialdehyde level were compared before and after intervention.
  
  
  RESULTS
  The near-normoglycemia rate at the third month in CSII alone and that in combination with rosiglitazone, metformin, or α-lipoic acid was 72.5%, 87.5%, 90%, and 75%, respectively (metformin group vs. CSII alone, P=0.045). The metformin group achieved euglycemia in a shorter time (2.6 ± 1.3 vs. 3.7 ± 1.8 days, P=0.020) with less daily insulin dosage and was more powerful in lowering total cholesterol, increasing AIR and HOMA β-cell function, whereas reduction of IMCL in the soleus was more obvious in the rosiglitazone group but not in the metformin group. The efficacy of combination with α-lipoic acid was similar to that of CSII alone.
  
  
  CONCLUSIONS
  Short-term CSII in combination with rosiglitazone or metformin is superior to CSII alone, yet the efficacy of the two differs in some way, whereas that with α-lipoic acid might not have an additive effect.
authors.affiliation: Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-sen University , Guangzhou, Guangdong, People's Republic of China .
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Huang
authors.forename: Xuesi
authors.initials: X
authors.lastname: Wan
authors.forename: Juan
authors.initials: J
authors.lastname: Liu
authors.forename: Wanping
authors.initials: W
authors.lastname: Deng
authors.forename: Ailing
authors.initials: A
authors.lastname: Chen
authors.forename: Liehua
authors.initials: L
authors.lastname: Liu
authors.forename: Jianbin
authors.initials: J
authors.lastname: Liu
authors.forename: Guohong
authors.initials: G
authors.lastname: Wei
authors.forename: Hai
authors.initials: H
authors.lastname: Li
authors.forename: Donghong
authors.initials: D
authors.lastname: Fang
authors.forename: Yanbing
authors.initials: Y
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000627:therapeutic use*; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005215:Fasting; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007332:Insulin Infusion Systems; D050417:Insulin-Secreting Cells / Q000187:drug effects; D008055:Lipids / Q000097:blood; D008297:Male; D008315:Malondialdehyde / Q000378:metabolism; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000627:therapeutic use*; D008063:Thioctic Acid / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D000975:Antioxidants; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008055:Lipids; D008315:Malondialdehyde; D008687:Metformin; D000077154:Rosiglitazone; D045162:Thiazolidinediones; D008063:Thioctic Acid; C517652:hemoglobin A1c protein, human