Combination therapy for type 2 diabetes: repaglinide plus rosiglitazone.

Area of Science:

• Endocrinology
• Metabolic Diseases
• Pharmacology

Background:

• Type 2 diabetes management often requires combination therapy for patients with inadequate glycemic control on monotherapy.
• Sulfonylurea and metformin are common first-line agents, but some patients exhibit unsatisfactory responses.

Purpose of the Study:

• To compare the efficacy and safety of repaglinide monotherapy, rosiglitazone monotherapy, and a combination of repaglinide plus rosiglitazone.
• To evaluate treatment outcomes in Type 2 diabetes patients with prior unsatisfactory response to oral monotherapy.

Main Methods:

• A 24-week, randomized, multicenter, open-label, parallel-group clinical trial.
• 252 adult patients with Type 2 diabetes and HbA1c > 7.0% after monotherapy were randomized to repaglinide, rosiglitazone, or combination therapy.
• Efficacy was assessed by changes in HbA1c (primary) and fasting plasma glucose (secondary) after dose optimization and maintenance periods.

Main Results:

• Combination therapy (repaglinide/rosiglitazone) achieved greater mean HbA1c reduction (-1.43%) compared to repaglinide (-0.17%) or rosiglitazone (-0.56%) monotherapy.
• Fasting plasma glucose reductions were also significantly greater with combination therapy (-5.2 mmol/l) versus monotherapies.
• Minor hypoglycemic events were observed in 9% of combination therapy patients, versus 6% for repaglinide and 2% for rosiglitazone.

Conclusions:

• Repaglinide/rosiglitazone combination therapy is well-tolerated and demonstrates superior glycemic reduction in Type 2 diabetes patients.
• Combination therapy is an effective strategy for patients with insufficient response to oral antidiabetic monotherapy.