Single or divided
Figure 75 Many drugs are marketed for the treatment of type 2 diabetes, but most centers confine themselves to the use of one sulfonylurea, metformin and the glitazones with more sporadic use of acarbose and the meglitinides. The United Kingdom Prospective Diabetes Study has testified to the benefit of the use of metformin alone in obese patients and confirmed the safety of sulfonylureas. The PROactive study (PROspective pioglitAzone Clinical Trial in macro Vascular Events) of the use of pioglitazone in patients with type 2 diabetes and evidence of established macrovascular disease showed a lower proportion of patients reaching the secondary composite end points of all-cause mortality, non-fatal myocardial infarction and stroke with no effect on the more extensive primary end points. In most countries the meglitinides and a-glucosidase inhibitors are being used less frequently. Avandamet is a useful combination drug containing rosiglitazone and metformin. Glucophage SR, a slow-release version of metformin, may be given once daily and may have fewer gastrointestinal side-effects
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