Insulin resistance is a major endocrinopathy underlying the development of 
hyperglycaemia and cardiovascular disease in type 2 diabetes. Metformin (a 
biguanide) and rosiglitazone (a thiazolidinedione) counter insulin resistance, 
acting by different cellular mechanisms. The two agents can be used in 
combination to achieve additive glucose-lowering efficacy in the treatment of 
type 2 diabetes, without stimulating insulin secretion and without causing 
hypoglycaemia. Both agents also reduce a range of atherothrombotic factors and 
markers, indicating a lower cardiovascular risk. Early intervention with 
metformin is already known to reduce myocardial infarction and increase survival 
in overweight type 2 patients. Recently, a single-tablet combination of 
metformin and rosiglitazone, Avandamet, has become available. Avandamet is 
suitable for type 2 diabetic patients who are inadequately controlled by 
monotherapy with metformin or rosiglitazone. Patients already receiving separate 
tablets of metformin and rosiglitazone may switch to the single-tablet 
combination for convenience. Also, early introduction of the combination before 
maximal titration of one agent can reduce side effects. Use of Avandamet 
requires attention to the precautions for both metformin and rosiglitazone, 
especially renal, cardiac and hepatic competence. In summary, Avandamet is a 
single-tablet metformin-rosiglitazone combination that doubly targets insulin 
resistance as therapy for hyperglycaemia and vascular risk in type 2 diabetes.