Combination of Metformin and Thiazolidinediones in Type 2 Diabetes Mellitus- A Review

Abstract

Combination therapy, in modern medicine, has come a long way in the management of chronic disorders or syndromes. Diabetes mellitus, which is rather considered a syndrome, is characterised by persistent hyperglycaemia due to relative or absolute insulin deficiency and or
resistance. Type 2 Diabetes mellitus, in which insulin resistance is the prominent feature, has a higher prevalence in the population globally despite the enormous resources spent annually on research in this field. Initial treatment in patients with type 2 is often in a stepped care progression, starting with a regimen of medical therapy nutrition and exercise and progressing to therapy with oral glucose lowering agents. In type 2, patients often exhibit poor response to monotherapy thus paving way for combination therapy often using two or more agents. This forms the basis of this review on the role of combination therapy using metformin and thiazolidinediones in type 2 notwithstanding the fact that there are some pros and cons associated with the use of thiazolidinediones either alone or in combination and this remains a subject of discussion at both national and international levels. review of relevant literature was conducted using manual library search and internet articles. Other relevant websites were also visited to source for
information. The key words employed were: diabetes mellitus, metformin, thiazolidinediones, and combination therapy. several studies show that the use of metformin and thiazolidinediones in type 2 diabetic patients significantly leads to improvement in glucose control, without stimulation of insulin secretion or causing hypoglycaemia. This benefit is not without some unwanted effects which is often associated with thiazolidinediones, a subject that is still debatable in the medical circle. This review was able to underscore the importance of combination therapy using metformin and thiazolidinediones in type 2 diabetes mellitus as it significantly lowered
fasting and postprandial plasma glucose concentrations; it also reasonably lowers the mean glycosylated haemoglobin and should be borne in mind that HbA1C could be unreliable in populations with high prevalence of HbSS since haemoglobinopathies influence glycosylated haemoglobin results and thus its interpretation. It also touches on the arguments associated with the use of thiazolidinediones which is still a subject of discussion at both national and international levels.

Key Words- Diabetes Mellitus, Metformin, Combination Therapy, Thiazolidinedione, Rosiglitazone