A Prospective Audit of Triple Therapy in Type 2 Patients
A James, DM Levy & RM Davison
We conducted a prospective audit of triple therapy in type 2 patients (Dec01 to Dec02). 51 patients on maximal Metformin and sulphonylurea had a Glitazone added. 11 patients were lost to follow up. The remaining 40 patients, 23 Male, 17 Female, mean age 51years (35-66), diabetes mean duration 8.5 years (2-16) had a mean BMI of 33.8 (range 22-47). Mean baselineHbA1C was 9.6% (7.3-12.3%).
Parameters measured were blood pressure, height, weight BMI, full blood count, lipid profiles, liver function tests, renal chemistry, HbA1C urinary albumin excretion at baseline and thereafter at two monthly intervals. A fall in HbA1C of 1% or more after 6 months or more of treatment was considered as response.
Mean follow up was 11 months. No patient withdrew due to adverse side effects. 23 (57%) (12M,11F) patients responded to the addition of a Glitazone to their treatment. Among responders, the mean drop in HbA1C was 1.9% (range 1-3.5%) compared to a mean increase of 0.1% (range -0.9-1.8%) in non-responders. Responders had a mean weight gain of 5.28 kgs (5.8%) (-3.9 - 12.2 kgs) as compared to 2.08 kgs (2.2%) (-2.1-6kgs) among non-responders. The response rate was higher in Asians (57%) than Caucasians (44%). ALT dropped by 5.2 units (17.7%) in responders as compared to 2.2 units (7.7%) in non-responders (within the normal reference range). 14 patients followed up for 12 months continued to show a drop in HbA1c.
Triple oral therapy is safe and effective even in patients with a relatively long duration of diabetes
It is more effective in Asians possibly due to greater insulin resistance
Liver function improves with Glitazone therapy
. Benefits of triple therapy are sustained beyond 6 months