Type 2 diabetes mellitus is characterised by multiple defects including decreased insulin mediated glucose disposal, higher endogenous glucose production mainly from liver and inadequate pancreatic secretion of insulin. Metformin and thiazolidinediones (TZDs) decrease insulin resistance by different mechanisms of action, and since both have the advantage of decreasing hyperglycaemia without increasing insulin secretion, they make an attractive option for combination. Metformin decreases hepatic glucose production and enhances peripheral glucose uptake while TZDs, by acting on peroxisome proliferator-activated receptor-gamma (PPARγ) receptors increase glucose uptake.
The combination has also been shown to improve glycaemic control, improve insulin sensitivity and improve beta-cell function. The availability of the two drugs in one pill has the potential to improve patientcompliance and decrease costs.
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