Ralph A. DeFronzo, MD
DeFronzo RA. Pharmacologic Therapy for Type 2 Diabetes Mellitus. Ann Intern Med. 2000;133:73-74. doi: 10.7326/0003-4819-133-1-200007040-00016
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Published: Ann Intern Med. 2000;133(1):73-74.
TO THE EDITOR:
After publication of my article on therapy for type 2 diabetes (1), the Food and Drug Administration (FDA) withdrew troglitazone as monotherapy for the treatment of patients with this disease. The FDA has approved two new thiazolidinediones, rosiglitazone and pioglitazone, for this indication. A revised algorithm (Figure) takes into account these actions taken by the FDA.
At present, few of the primary treatment trials with rosiglitazone and pioglitazone have been published. However, data presented in abstract form, in the package insert, and in initial publications suggest that both thiazolidinediones are similar with regard to glucose-lowering efficacy, and they both decrease hemoglobin A1c values by 1.1 to 1.5 percentage points in patients with type 2 diabetes. Varying results can be explained by differences in the hemoglobin A1c value at baseline (the higher the baseline value, the greater the subsequent reduction) and expression of the hypoglycemic potency as change from placebo versus change from baseline.
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