Traditional first-line intervention in patients with type 2 diabetes and very poor glycemic control is insulin therapy or high doses of sulfanylureas if there is no evidence of volume depletion. This review assesses the efficacy and safety of rosiglitazone and metformin fixed dose combination (avandamet) as initial therapy in patients with uncontrolled type 2 diabetes. This combination therapy achieved significant reduction in A1c and fasting plasma glucose compared with either rosiglitazone or metformin monotherapy as demonstrated by various studies. This combination was generally well tolerated as initial therapy, with no new tolerability issue identified with the fixed-dose combination, with tolerability profile similar to metformin alone. The marked benefit of this combination is the product of the complementary actions of these two agents.

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