Combination therapy using metformin or thiazolidinediones and insulin in the treatment of diabetes mellitus

摘要: The biguanide, metformin, sensitizes the liver to effect of insulin, suppressing hepatic glucose output. Thiazolidinediones such as rosiglitazone and pioglitazone enhance insulin-mediated disposal, leading reduced plasma insulin concentrations. These classes drugs may also have varying beneficial effects on features resistance lipid levels, blood pressure body weight. Metformin in combination with has been shown significantly improve levels while lowering total daily dose thiazolidinediones effective dose. Triple therapy using metformin a thiazolidinedione improves glycaemic control greater degree than dual or thiazolidinedione. There is insufficient evidence recommend use type 1 diabetic patients. Although these agents are largely well tolerated, some subjects experience significant gastrointestinal problems metformin. associated low risk lactic acidosis, but should not be used patients elevated serum creatinine those being treated for congestive heart failure. an increase weight, although this can avoided careful lifestyle management. lead oedema incidence hepatocellular injury. contraindicated underlying disease who at failure abnormal function. desired glucose-lowering adverse event profiles considered when recommending potential impact long-term cardiovascular outcomes remains under investigation.