The combination of rosiglitazone and metformin
reduced the rate of treatment failure as compared
with metformin monotherapy, despite a
small increase in BMI and fat mass in the rosiglitazone-treated
participants. Whether the effect
shown in this study is specific for rosiglitazone,
a more general effect of thiazolidinediones, or a
feature of combination therapy is unclear. This
question is of particular importance, given the
currently restricted status of rosiglitazone in the
United States and Europe. The absence of adverse
events related to rosiglitazone, including the absence
of an identified effect of rosiglitazone on
bone density in this cohort of children and adolescents,
an age group characterized by skeletal
growth, should be interpreted cautiously, given the
limited sample size.