The results of ADOPT are controversial, because the modest glycemic benefits of the thiazolidinedione must be balanced against higher cost and a less favorable adverse effect profile than metformin, leaving the choice of Rosiglitazone had fewer gastrointestinal side effects than metformin and less hypoglycemia than glyburide.ĪDOPT was not designed to evaluate cardiovascular disease outcomes, and whether the advantages of rosiglitazone in glycemic control translate into prevention of microvascular and macrovascular disease outcomes need to be tested in longer term trials in higher risk patients. Heart failure was equally frequent with the two treatments. Balanced against its advantages in lowering glucose levels are the adverse effects of the thiazolidinedione: weight gain (average 4.8kg over 4 years in ADOPT versus 2.9kg weight loss for metformin) and edema. Both the rosiglitazone and metformin performed better than glyburide, providing additional evidence that sulfonylurea treatment for the new onset diabetic patient is suboptimal. The multicenter A Diabetes Outcome Progression Trial (ADOPT) demonstrated that the thiazolidinedione rosiglitazone is more effective than the biguanide metformin or the sulfonylurea glyburide in maintaining glycemic control when used as initial treatment for recentlyĭiagnosed type 2 diabetes. This study offers a head-to-head comparison of oral glycemic-lowering agents few of those comparisons are otherwise available in the literature. Related to the worldwide epidemic of obesity, newly diagnosed type 2 diabetes has become an increasingly common problem in general medical practice, raising questions about the best way to initiate treatment. ).Ĭopyright 2006 Massachusetts Medical Society. Rosiglitazone was associated with more weight gain and edema than either metformin or glyburide but with fewer gastrointestinal events than metformin and with less hypoglycemia than glyburide (P< 0.001 for all comparisons).ĬONCLUSIONS: The potential risks and benefits, the profile of adverse events, and the costs of these three drugs should all be considered to help inform the choice of pharmacotherapy for patients with type 2 diabetes. Glyburide was associated with a lower risk of cardiovascular events (including congestive heart failure) than was rosiglitazone (P< 0.05), and the risk associated with metformin was similar to that with rosiglitazone. The difference in the durability of the treatment effect was greater between rosiglitazone and glyburide than between rosiglitazone and metformin. This represents a risk reduction of 32% for rosiglitazone, as compared with metformin, and 63%, as compared with glyburide (P< 0.001 for both comparisons). RESULTS: Kaplan-Meier analysis showed a cumulative incidence of monotherapy failure at 5 years of 15% with rosiglitazone, 21% with metformin, and 34% with glyburide. Prespecified secondary outcomes were levels of fasting plasma glucose and glycated hemoglobin, insulin sensitivity, and beta-cell function. The primary outcome was the time to monotherapy failure, which was defined as a confirmed level of fasting plasma glucose of more than 180 mg per deciliter (10.0 mmol per liter), for rosiglitazone, as compared with metformin or glyburide. The patients were treated for a median of 4.0 years. METHODS: We evaluated rosiglitazone, metformin, and glyburide as initial treatment for recently diagnosed type 2 diabetes in a double-blind, randomized, controlled clinical trial involving 4360 patients. ![]() BACKGROUND: The efficacy of thiazolidinediones, as compared with other oral glucose-lowering medications, in maintaining long-term glycemic control in type 2 diabetes is not known.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |