Metformin plus Roziglitazone versus Metformin for Type 2 Diabetes: A Systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Junying ^1,2 , MA Bin ¹ , YANG Kehu ¹ ,  CHENG Weidong ²

1. Evidence-based Medicine Center, Basic Medical Sciences School of Lanzhou University, Lanzhou 730000, China;2. Institute of Integrated Traditional and Western Medicine, Lanzhou University, Lanzhou 730000, China;

Corresponding author：

CHENG Weidong, Email: zhangjuny1985@163.com

Keywords：

Diabetes mellitus, type 2; Metformin; Rosiglitazone; Systematic review

DOI：

10.7507/1672-2531.20090082

Video：

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Objectives 　To assess the efficacy and safety of metformin plus rosiglitazone in treating type 2 diabetes mellitus.
Methods 　Based on the principles and methods of Cochrane systematic reviews, we searched the Cochrane
Library (2008, 4 issue), PubMed (1966 to October 19, 2008), Embase (1974 to October 19, 2008), China Biomedical
Literature Database (1978 to October 12, 2008), China Journal Fulltext Database (1994 to October 12, 2008), Chinese
Scientific Journals Full text Database (1989 to October 12, 2008). Randomized controlled trials (RCTs) of Metformin
plus roziglitazone versus metformin for type 2 diabetes were included. We assessed the quality of the included RCTs
according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis.
Results　 Twelve RCTs totaling 3020 patients were included. Metaanalysis showed that Glycosylated hemoglobin levels [WMD= – 0.48%, 95%CI (– 0.74, – 0.22), P=0.000 3], fasting plasma glucose levels [WMD= – 1.03mmol/L, 95%CI (– 1.85, – 0.75), P lt;0.000 01], insulin sensitivity, and β-cell function improved significantly with metformin plus rosiglitazone therapy. Compared with the metformin monotherapy group, patients treated with metformin plus rosiglitazone had more edema events [RR= 3.27, 95%CI (1.80, 5.91), P lt;0.000 1] and lower gastro-intestinal events [RR= 0.82, 95%CI (0.71, 0.94), P=0.004]. We found no statistically significant effect on body weight, the percentage of patients with at least one adverse event, and hypoglycemia events.
Conclusions　 Current evidence demonstrates that combination treatment with metformin plus rosiglitazone improves glycemic control, insulin sensitivity, and cells function more effectively than with metformin monotherapy. Side effects of two types of therapy have differences in performance.

Citation： ZHANG Junying,MA Bin,YANG Kehu,CHENG Weidong. Metformin plus Roziglitazone versus Metformin for Type 2 Diabetes: A Systematic review. Chinese Journal of Evidence-Based Medicine, 2009, 09(4): 437-445. doi: 10.7507/1672-2531.20090082 Copy

1.	World Health Organization. Types of Diabetes. Available from URL:http://www.who.int/diabetesactiononline/diabetes/basics/en/index1.html.
2.	世界卫生组织. 糖尿病. Available from URL: http://www.who.int/mediacentre/factsheets/fs312/zh/index.html.
3.	International Diabetes Federation (2005): Global Guidelines for type 2 diabetes. Available from URL: http://www.idf.org/webdata/docs/GGT2D%2009%20Oral%20therapy.pdf.
4.	Bailey CJ, Del Prato S, Eddy D, et al. Earlier intervention in type 2 diabetes: the case for achieving early and sustained glycaemic control. Int J Clin Pract, 2005, 59(11): 1309-1316.
5.	Garber AJ. Using dose-response characteristics of therapeutics agents for treatment decisions in type 2 diabetes. Diabetes Obes Metab, 2000, 2(3): 139-147.
6.	Inzucchi SE, Maggs DG, Spollett GR, et al. Efficacy and metabolic effects of metformin and troglitazone in type II diabetes mellitus. N Engl J Med, 1998, 338(13): 867-872.
7.	Davidson MB, Peters AL. An overview of metformin in the treatment of type 2 diabetes mellitus. Am J Med, 1997, 102(1):.
8.	Diamant M, Heine RJ. Thiazolidinediones in type 2 diabetes mellitus: current clinical evidence. Drugs, 2003, 63(13): 1373-1405.
9.	Stewart MW, Cirkel DT, Furuseth K, et al. Effect of metformin plus roziglitazone compared with metformin alone on glycaemic control in well-controlled Type 2 diabetes. Diabet Med, 2006, 23(10): 1069-1078.
10.	Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med, 1998, 15(7): 539-553.
11.	American Diabetes Association. Standards of medical care in diabetes--2007. Diabetes Care, 2007, 30(Suppl 1): S4-S41.
12.	Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia, 1985, 28(7): 412-419.
13.	Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care, 2000, 23(1): 57-63.
14.	Rosenstock J, Rood J, Cobitz A, et al. Initial treatment with rosiglitazone/metformin fixed-dose combination therapy compared with monotherapy with either rosiglitazone or metformin in patients with uncontrolled type 2 diabetes. Diabetes Obes Metab, 2006, 8(6): 650-660.
15.	Stewart MW, Cirkel DT, Furuseth K, et al. Effect of metformin plus roziglitazone compared with metformin alone on glycaemic control in well-controlled Type 2 diabetes. Diabet Med, 2006, 23(10): 1069-1078.
16.	Bailey CJ, Bagdonas A, Rubes J, et al. Rosiglitazone/metformin fixed-dose combination compared with uptitrated metformin alone in type 2 diabetes mellitus: a 24-week, multicenter, randomized, double-blind, parallel-group study. Clin Ther, 2005, 27(10): 1548-1561.
17.	Weissman P, Goldstein BJ, Rosenstock J, et al. Effects of rosiglitazone added to submaximal doses of metformin compared with dose escalation of metformin in type 2 diabetes: the EMPIRE Study. Curr Med Res Opin, 2005, 21(12): 2029-2035.
18.	Gómez-Perez FJ, Fanghänel-Salmón G, Antonio Barbosa J, et al. Efficacy and safety of rosiglitazone plus metformin in Mexicans withtype 2 diabetes. Diabetes Metab Res Rev, 2002, 18(2): 127-134.
19.	Fonseca V, Rosenstock J, Patwardhan R, et al. Effect of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus: a randomized controlled trial. JAMA, 2000, 283(13): 1695-1702.
20.	Negro R, Mangieri T, Dazzi D, et al. Rosiglitazone effects on blood pressure and metabolic parameters in nondipper diabetic patients. Diabetes Res Clin Pract, 2005, 70(1): 20-25.
21.	杜其玲, 刘承芬, 唐红英. 二甲双胍和罗格列酮治疗新诊2型糖尿病的疗效比较. 中外健康文摘?医药学刊, 2007, 4(12): 4-5.
22.	韩书宏, 胡海科, 张翼飞, 等. 罗格列酮与二甲双胍联用治疗2型糖尿病疗效观察. 四川医学, 2007, 28(1): 51-52.23 热阳古丽?沙塔尔, 阿孜古力?胡达拜地. 文迪雅联合二甲双胍治疗2型糖尿病的疗效观察. 中华临床医学研究杂志, 2007, 13(9): 1219.
23.	王淑芳, 曲晓红, 赵颖. 罗格列酮和二甲双胍治疗新发2型糖尿病的疗效比较. 中国糖尿病杂志, 2006, 14(6): 415-416.
24.	-110.

1. World Health Organization. Types of Diabetes. Available from URL:http://www.who.int/diabetesactiononline/diabetes/basics/en/index1.html.
2. 世界卫生组织. 糖尿病. Available from URL: http://www.who.int/mediacentre/factsheets/fs312/zh/index.html.
3. International Diabetes Federation (2005): Global Guidelines for type 2 diabetes. Available from URL: http://www.idf.org/webdata/docs/GGT2D%2009%20Oral%20therapy.pdf.
4. Bailey CJ, Del Prato S, Eddy D, et al. Earlier intervention in type 2 diabetes: the case for achieving early and sustained glycaemic control. Int J Clin Pract, 2005, 59(11): 1309-1316.
5. Garber AJ. Using dose-response characteristics of therapeutics agents for treatment decisions in type 2 diabetes. Diabetes Obes Metab, 2000, 2(3): 139-147.
6. Inzucchi SE, Maggs DG, Spollett GR, et al. Efficacy and metabolic effects of metformin and troglitazone in type II diabetes mellitus. N Engl J Med, 1998, 338(13): 867-872.
7. Davidson MB, Peters AL. An overview of metformin in the treatment of type 2 diabetes mellitus. Am J Med, 1997, 102(1):.
8. Diamant M, Heine RJ. Thiazolidinediones in type 2 diabetes mellitus: current clinical evidence. Drugs, 2003, 63(13): 1373-1405.
9. Stewart MW, Cirkel DT, Furuseth K, et al. Effect of metformin plus roziglitazone compared with metformin alone on glycaemic control in well-controlled Type 2 diabetes. Diabet Med, 2006, 23(10): 1069-1078.
10. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med, 1998, 15(7): 539-553.
11. American Diabetes Association. Standards of medical care in diabetes--2007. Diabetes Care, 2007, 30(Suppl 1): S4-S41.
12. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia, 1985, 28(7): 412-419.
13. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care, 2000, 23(1): 57-63.
14. Rosenstock J, Rood J, Cobitz A, et al. Initial treatment with rosiglitazone/metformin fixed-dose combination therapy compared with monotherapy with either rosiglitazone or metformin in patients with uncontrolled type 2 diabetes. Diabetes Obes Metab, 2006, 8(6): 650-660.
15. Stewart MW, Cirkel DT, Furuseth K, et al. Effect of metformin plus roziglitazone compared with metformin alone on glycaemic control in well-controlled Type 2 diabetes. Diabet Med, 2006, 23(10): 1069-1078.
16. Bailey CJ, Bagdonas A, Rubes J, et al. Rosiglitazone/metformin fixed-dose combination compared with uptitrated metformin alone in type 2 diabetes mellitus: a 24-week, multicenter, randomized, double-blind, parallel-group study. Clin Ther, 2005, 27(10): 1548-1561.
17. Weissman P, Goldstein BJ, Rosenstock J, et al. Effects of rosiglitazone added to submaximal doses of metformin compared with dose escalation of metformin in type 2 diabetes: the EMPIRE Study. Curr Med Res Opin, 2005, 21(12): 2029-2035.
18. Gómez-Perez FJ, Fanghänel-Salmón G, Antonio Barbosa J, et al. Efficacy and safety of rosiglitazone plus metformin in Mexicans withtype 2 diabetes. Diabetes Metab Res Rev, 2002, 18(2): 127-134.
19. Fonseca V, Rosenstock J, Patwardhan R, et al. Effect of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus: a randomized controlled trial. JAMA, 2000, 283(13): 1695-1702.
20. Negro R, Mangieri T, Dazzi D, et al. Rosiglitazone effects on blood pressure and metabolic parameters in nondipper diabetic patients. Diabetes Res Clin Pract, 2005, 70(1): 20-25.
21. 杜其玲, 刘承芬, 唐红英. 二甲双胍和罗格列酮治疗新诊2型糖尿病的疗效比较. 中外健康文摘?医药学刊, 2007, 4(12): 4-5.
22. 韩书宏, 胡海科, 张翼飞, 等. 罗格列酮与二甲双胍联用治疗2型糖尿病疗效观察. 四川医学, 2007, 28(1): 51-52.23 热阳古丽?沙塔尔, 阿孜古力?胡达拜地. 文迪雅联合二甲双胍治疗2型糖尿病的疗效观察. 中华临床医学研究杂志, 2007, 13(9): 1219.
23. 王淑芳, 曲晓红, 赵颖. 罗格列酮和二甲双胍治疗新发2型糖尿病的疗效比较. 中国糖尿病杂志, 2006, 14(6): 415-416.
24. -110.

Chinese Journal of Evidence-Based Medicine

Metformin plus Roziglitazone versus Metformin for Type 2 Diabetes: A Systematic review

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