Showing papers by "Silvio E. Inzucchi published in 1998"
TL;DR: Metformin and troglitazone have equal and additive beneficial effects on glycemic control in patients with type 2 diabetes.
Abstract: Background Combination therapy is logical for patients with non-insulin-dependent (type II) diabetes mellitus, because they often have poor responses to single-drug therapy. We studied the efficacy and physiologic effects of metformin and troglitazone alone and in combination in patients with type II diabetes. Methods We randomly assigned 29 patients to receive either metformin or troglitazone for three months, after which they were given both drugs for another three months. Plasma glucose concentrations during fasting and postprandially and glycosylated hemoglobin values were measured periodically during both treatments. Endogenous glucose production and peripheral glucose disposal were measured at base line and after three and six months. Results During metformin therapy, fasting and postprandial plasma glucose concentrations decreased by 20 percent (58 mg per deciliter [3.2 mmol per liter], P<0.001) and 25 percent (87 mg per deciliter [4.8 mmol per liter], P<0.001), respectively. The corresponding decr...
793 citations
Journal Article•
TL;DR: This issue is studied using detailed metabolic measurements in a large group of patients with type 2 diabetes mellitus, and it is not clear whether troglitazone exerts its major insulin-sensitizing effect predominantly in the liver or in peripheral tissues.
Abstract: Background: Troglitazone is a new insulin-sensitizing agent used to treat type 2 diabetes mellitus. The mechanism by which troglitazone exerts its effect on systemic glucose metabolism is unknown. ...
289 citations
TL;DR: Troglitazone is a new insulin-sensitizing agent used to treat type 2 diabetes mellitus as mentioned in this paper, which is unknown mechanism by which it exerts its effect on systemic glucose metabolism.
Abstract: Background: Troglitazone is a new insulin-sensitizing agent used to treat type 2 diabetes mellitus The mechanism by which troglitazone exerts its effect on systemic glucose metabolism is unknown Objective: To determine the effects of 6 months of troglitazone monotherapy on glucose metabolism in patients with type 2 diabetes mellitus Design: Randomized, double-blind, placebo-controlled trial Setting: Six general clinical research centers at university hospitals Patients: 93 patients (mean age, 52 years) with type 2 diabetes mellitus (mean fasting plasma glucose level, 112 mmol/L) who were being treated with diet alone or who had discontinued oral antidiabetic medication therapy Intervention: Patients were randomly assigned to one of five treatment groups (100, 200, 400, or 600 mg of troglitazone daily or placebo) and had metabolic assessment before and after 6 months of treatment Measurements: Plasma glucose and insulin profiles during a meal tolerance test; basal hepatic glucose production and insulin-stimulated glucose disposal rate during a hyperinsulinemic-euglycemic clamp procedure Results: Troglitazone at 400 and 600 mg/d decreased both fasting (P < 0001) and postprandial (P = 0016) plasma glucose levels by approximately 20% All four troglitazone dosages also decreased fasting (P = 0012) and postprandial (P < 0001) triglyceride levels; 600 mg of the drug per day decreased fasting free fatty acid levels (P = 0018) Plasma insulin levels decreased in the 200-, 400-, and 600-mg/d groups (P < 0001), and C-peptide levels decreased in all five study groups (P < 0001) Basal hepatic glucose production was suppressed in the 600-mg/d group compared with the placebo group (P = 002) Troglitazone at 400 and 600 mg/d increased glucose disposal rate by approximately 45% above pretreatment levels (P = 0003) Stepwise regression analysis showed that troglitazone therapy was the strongest predictor of a decrease in fasting (P < 0001) or postprandial (P = 001) glucose levels Fasting C-peptide level was the next strongest predictor (higher C-peptide level equaled greater glucose-lowering effect) Conclusion: Troglitazone monotherapy decreased fasting and postprandial glucose levels in patients with type 2 diabetes, primarily by augmenting insulin-mediated glucose disposal
280 citations
5 citations
TL;DR: This appears to be the first case of ectopic thymic carcinoid presenting as a thyroid nodule presenting in a cervical remnant of the thymus.
Abstract: A 26-year old woman presented with a thyroid nodule. Ultrasound and scintigraphy confirmed the presence of a 3.5-cm non-functioning mass in the left lobe. A fine needle aspiration demonstrated unusual, malignant-appearing cells, and thyroidectomy was performed. At gross pathological sectioning, the lesion was clearly attached to, but not part of, the thyroid. Microscopic features indicated an atypical carcinoid arising in a cervical remnant of the thymus. This appears to be the first case of ectopic thymic carcinoid presenting as a thyroid nodule.
3 citations