|
Thiazolidinedione/Biguanide Combination
A new trend in diabetes therapy is to combine commonly used medications into one product. The thought behind this is that many patients require more than one medication to control their diabetes. Taking multiple medications can be difficult to remember and to plan for proper timing of doses. While combining medications into one product may help with patient compliance, it also may make dosing adjustments more tricky.
The products in this class combine a thiazolidinedione with a biguanide.
The thiazolidinediones, which are a relatively recent development in the treatment of Type 2 diabetes, take a new approach to the condition that many clinicians believe is closer to its underlying causes. In most people suffering from this type of diabetes, there may be higher-than-normal levels of insulin, because the pancreas is secreting more in an attempt to compensate for high blood glucose levels. The problem is that the cells have developed an insulin resistance, which means that they do not respond insulin in the way they should. The thiazolidinediones address this resistance by improving the cell's response to glucose.
In May 2007, the FDA released a safety alert on rosiglitazone (brand name: Avandia) which stated there may be a potentially significant increase in the risk of heart attack and heart-related deaths in persons taking this drug. They have instructed these individuals (especially those who already have heart disease or those who are at high risk for developing heart disease) to talk to their doctor about this new information so an individualized plan can be made regarding these findings. The FDA is continuing to look into all available data on this topic and will report their findings once their research is completed.
The exact mechanism of the biguanides is not known, but the effects are well documented. Biguanides reduce insulin resistance in muscle cells and decrease the release of glucose from the liver. They also reduce the absorption of glucose in the small intestine, and may enhance insulin sensitivity inside the cell, as well as stimulate the disposal of glucose. Because biguanides do not stimulate insulin secretion, they do not cause hypoglycemia (low blood sugar). Biguanides may cause weight loss, which can be beneficial in obese patients.
Drugs in the class
Rosiglitazone and Metformin (Avandamet) | 
