|
|
 |
|
| •
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Biguanides:
metformin (Glucophage®) |
|
-
|
Decrease
hepatic glucose production |
|
-
|
Metformin
improves fasting insulin, insulin AUC, TG, and VAT:TAT1
|
| •
|
Glitazones:
rosiglitazone (Avandia®), pioglitazone (Actos®) |
|
-
|
Insulin
sensitizers fi> PPAR-g activity fifl TNF-a activity fifl
FFAs fi> hepatic insulin sensitivity fi> peripheral glucose
uptake |
| •
|
Combination
therapy |
|
-
|
Metformin
(2.5 g/d) + rosiglitazone (4-8 mg/d) are more effective in improving
glycemic control, insulin sensitivity, and b-cell function than
metformin alone2
|
• The biguanides decrease hepatic glucose production. In HIV-infected
patients, metformin has been found to improve fasting insulin levels,
insulin area under the curve (AUC) values, triglycerides, and the
ratio of visceral fat to total body fat.1
• The glitazones include rosiglitazone and pioglitazone. These
insulin sensitizers have a complex mechanism of action, ultimately
resulting in increased hepatic insulin sensitivity and increased peripheral
glucose uptake.
• As with non-HIV-infected patients, combination therapy may
also be used. Such an approach has been shown to be more effective
in improving glycemic control, insulin sensitivity, and beta-cell
function than monotherapy with metformin alone in patients with type
II diabetes who do not have HIV infection.2
References:
1. Saint-Marc T, Touraine JL. Effects of metformin on insulin resistance
and central adiposity in patients receiving effective protease inhibitor
(PI) therapy. 6th Conference on Retroviruses and Opportunistic Infections,
Chicago, IL; Jan 31 - Feb 4, 1999. Abstract 672.
2. Fonseca V, Rosenstock J, Patwardhan R, Salzman A. Effect of metformin
and rosiglitazone combination therapy in patients with type 2 diabetes
mellitus: a randomized controlled trial. JAMA. 2000;283:1695-1702.
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