Initial Metformin/Pioglitazone Combo Helps Patients Reach Glycaemic Targets Better Than Sequential Augmentation Therapy: Presented at EASD

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Title: Initial Metformin/Pioglitazone Combo Helps Patients Reach Glycaemic Targets Better Than Sequential Augmentation Therapy: Presented at EASD
URL: http://www.pslgroup.com/dg/22B6EE.htm
Doctor's Guide
September 8, 2008

By Jill Stein

ROME -- September 8, 2008 -- Type 2 diabetics treated initially with a combination of metformin and pioglitazone are more likely to achieve a haemoglobin (Hb) A1C level <7% than those who are treated with sequential augmentation therapy, according to results presented here at the European Association for the Study of Diabetes (EASD) 2008.

Bhavik J. Pandya, PhD, Takeda Pharmaceuticals, Deerfield, Illinois, and colleagues compared glycaemic goal attainment in patients type 2 diabetes treated with an initial combination of metformin and pioglitazone (either fixed-dose or loose-dose) versus those treated sequentially with initial metformin monotherapy and later augmented with pioglitazone.

The American Diabetes Association (ADA) currently recommends an Hb A1C level of <7%. But more intensive glycaemic control in patients with diabetes leads to fewer macrovascular and microvascular complications, Dr. Pandya stated in a presentation on September 8.

Previous research has shown that a combination of a thiazolidinedione and metformin improves glycaemic control compared with metformin alone in type 2 diabetics, he added.

Initiation with the thiazolidinedione/metformin combination will potentially provide greater control of Hb A1C than adding a thiazolidinedione to metformin after metformin has failed, he said.

The difference in clinical outcomes between initiation with combination therapy and sequential augmentation therapy has not been extensively studied in a naturalistic setting, he noted.

Therefore, Dr. Pandya and colleagues enrolled 561 patients drawn from a large managed-care database that covers more than 30 health plans. Overall, 213 patients received combination therapy and 348 received augmentation therapy.

Results at month 6 showed that 70.9% of the combination-therapy group achieved the Hb A1C goal of <7% versus 49.4% of patients in the augmentation group. At 12 months, 68.5% of the combination group achieved the goal versus 46.6% of the augmentation group.

At month 18, 67.1% and 46.0% of the 2 groups, respectively, achieved the goal Hb A1C level, and 67.1% and 45.7% of the 2 groups, respectively, achieved the goal at 24 months, (all P < .0001).

Dr. Pandya cautioned that while the sample sizes in some subgroups were limited, the results remain significant given the large differences in outcomes between the comparison subgroups.

Overall, the findings demonstrate that patients treated with initial combination therapy are more likely to attain their glycaemic target than those treated with sequential augmentation therapy, he said. Initiating pioglitazone at the same time as metformin may thus provide better diabetes control than adding pioglitazone to metformin after metformin has failed.

Funding for the study was provided by Takeda Pharmaceuticals.

[Presentation title: Achieving Glycemic Goal With Initial Combination Therapy Versus Sequential Augmentation Therapy Using Metformin and Pioglitazone. Abstract 921]

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