Triple Therapy

In this issue of Diabetes Care , Strowig, Aviles-Santa, and Raskin (1) evaluated the glycemic response to “triple therapy” in a small number of patients. Their study of triple therapy involved adding metformin to type 2 diabetic patients receiving >30 units of insulin plus troglitazone or adding troglitazone to similar patients receiving >30 units of insulin plus metformin. The added oral antidiabetes medications were titrated upward over 1 month to maximal doses and the patients followed for another 3 months without further changes in their doses. Insulin doses were not allowed to be increased but could be decreased in response to hypoglycemia. Although these patients were well controlled at baseline, their control improved even further with this triple therapy. A1C levels in patients in whom troglitazone was added fell from 7.0 ± 0.8% (mean ± SD) at baseline to 6.1 ± 0.4%. Corresponding changes in A1C levels in the group receiving metformin as the third medication were 6.2 ± 0.8 to 5.8 ± 0.6%. There is no agreement on what constitutes …