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Objective: To study the effect of different daily doses of pioglitazone on glycemic control and weight gain in newly-diagnosed type 2 diabetes mellitus (DM) patients., Research Design and Methods: Chart reviews were performed of recently-diagnosed (<24 months) type 2 DM patients receiving oral therapy including pioglitazone. Patients were excluded if they had heart disease, liver dysfunction or renal insufficiency; or were being treated with insulin or the incretin drugs. Patients had received 7.5 mg/day (Group A), 15 mg/day (Group B) or 30 mg/day (Group C) of pioglitazone. Characteristics including demographics, weight, body mass index and glycated hemoglobin (HbA1c) were recorded at baseline and at six months., Results: At the end of six months, there was significant weight gain in all groups from baseline (P<0.01). Weight gain was greatest in Group C (2.72 kg; SD=2.97), intermediate in Group B (1.62 kg; SD=2.91) and least in Group A (0.88 kg; SD=2.77). The difference was statistically significant between Groups A and C; and Groups B and C; but not between Groups A and B. There was no difference between HbA1c lowering in the three groups (P>0.05). Dose correlated with weight gain (r=0.254; P<0.001) but not with HbA1c reduction (r=0.012; P=0.85). There was no correlation between HbA1c reduction and BMI increase (r = -0.024; P=0.72)., Conclusions: The glycemic effect of pioglitazone is preserved even at lower doses, while the propensity to cause weight gain increases with dose. We suggest that low-dose pioglitazone (7.5 mg/day) should be the preferred dose at which to initiate therapy in recently-diagnosed patients. Pioglitazone is an extremely useful agent in the treatment of type 2 diabetes mellitus (DM) through its actions on alleviating insulin resistance.

Aims and Objective: To study the effects of pioglitazone and metformin combination in type 2 diabetics in achieving long-term optimal glycemic control., Methods and Materials: Patients whose duration of type 2 diabetes was less than 24 months were selected for the study. 373 such patients meeting the selection criteria were included in the study and were started on triple drug combination therapy., Results: Three hundred seventy three (183 females and 190 males) patients were initiated on a triple drug combination of gliclazide 80 mg, tid, metformin 500 mg tid and pioglitazone 30 mg od. Once controlled, the doses of gliclazide were reduced if the blood glucose levels decreased. Those patients whose plasma glucose remained in the normal range for more than 6 months without the use of a sulphonylurea were considered to be in pharmacological remission. 48 patients were lost to follow up. At the beginning of the study the pre treatment biochemical parameters in these 325 diabetic patients at the time of enrolment were: average FBG of 209.44+/-73.82 mg/dl, PLBG 294.96+/-107.58 mg/dl, and HbA(1c) 11.21+/-3.85. The post treatment glycemic parameters were: FBG was 124.38+/-40.48 mg/dl (p < 0.0001), and PLBG 162.32+/-54.33 mg/dl (p < 0.001), average glycosylated hemoglobin was 6.45+/-2.17 (p < 0.001). After using the triple drug combination pharmacological remission was achieved in 36.3 percent i.e. 118 (60 males and 58 females) patients. The average time required for achieving remission was 4 (+/-3.3) months in males and 5 (+/-4.02) months in females. 118 patients were maintained remission after 2 years of follow up. The average duration of remission is 27 (+/-2.66) months. There was an average weight gain of 2.56 +/- 1.32 kg in both the groups of patients in remission and those who could not achieve remission., Conclusions: In this study we have found that we could achieve long term glycemic control 'pharmacological remission' in 118 of the 325 patients i.e.36% of type 2 diabetic patients. Insulin sensitizers like pioglitazone along with metformin may induce long-term glycemic control in type 2 diabetic patients.

Background: The thiazolidinediones are a class of antidiabetes medication that enhance the actions of insulin in muscle, liver, and adipose tissue. Data have been lacking on their use in combination with both sulfonylurea and metformin among patients of type 2 diabetes who are on insulin therapy secondary to failure of routine oral hypoglycemic drugs in controlling their diabetes., Objective: To determine the effects of pioglitazone in combination with sulphonylurea and metformin on diabetes control in patients being treated with insulin due to secondary failure of oral hypoglycemic agents., Patients: One hundred and twenty-four consecutive type 2 diabetes patients (mean age, 57.13 years) attending four centres in Mumbai, who were being treated with insulin were selected. They were switched on to triple drug combination of glibenclamide 5 mg, metformin 500 mg and pioglitazone 15 mg along with insulin. Study participants were required to have type 2 diabetes mellitus for atleast 5 years. Patients were excluded if they had any of the following: serum creatinine concentration greater than 1.5 mg/dl, alanine aminotransferase (ALT) level more than two times the upper limit of normal, symptomatic angina, cardiac insufficiency or history of myocardial infarction., Results: Pioglitazone 15 mg with glibenclamide 5 mg and metformin 500 mg, significantly decreased hemoglobin HbA1c level from 11.5% to 7.32% (P < 0.001), average fasting blood glucose from 194.8 mg/ dl to 124.06 mg/dl (p < 0.01), average post-prandial blood glucose from 256.24 to 162.32 mg/dl (p < 0.01). At 6 months, 43.35% of patients did not need to be continued on insulin. The total insulin requirement in 124 patients reduced by 71.81%. There were no significant side effects, liver enzymes were within acceptable levels, average weight gain was 2.23 kg, significant hypoglycemia was observed in 28 patients with two requiring hospitalisation, these patients were those who did not stick to follow-up schedules., Conclusions: With proper patient selection, pioglitazone with glibenclamide and metformin can be safely used in patients receiving insulin with good results.