Combination therapy for type II diabetes or syndrome X

Abstract

This invention provides methods of using a pharmacological combination of a biguanide agents, such as metformin, and one or more PTPase inhibiting agents and, optionally, one or more sulfonlylurea agents, including glyburide, glyburide, glipizide, glimepiride, chlorpropamide, tolbutamide, or tolazamide, for treatment in a mammal of Syndrome X, type II diabetes or metabolic disorders mediated by insulin resistance or hyperglycemia. Further included in this invention is a method of modulating blood glucose levels in a mammal utilizing the combination of one or more PTPase inhibiting agents and one or more sulfonlylurea agents.

What is claimed:  
     
         1 . A method for treatment of Syndrome X or type II diabetes in a mammal, the method comprising administering to a mammal in need thereof: 
 a) a pharmaceutically effective amount of a biguanide agent; and    b) a pharmaceutically effective amount of a PTPase inhibiting compound of formula I:                          wherein    Ar is                          A is hydrogen, halogen, or OH;    B and D are each, independently, hydrogen, halogen, CN, alkyl of 1-6 carbon atoms, aryl, aralkyl of 6-12 carbon atoms, hydroxyalkyl of 1-6 carbon atoms, hydroxyaralkyl of 6-12 carbon atoms, cycloalkyl of 3-8 carbon atoms, nitro, amino, —NR 1 R 1a , —NR 1 COR 1a , —NR 1 CO 2 R 1a , cycloalkylamino of 3-8 carbon atoms, morpholino, furan-2-yl, furan-3-yl, thiophen-2-yl, thiophen-3-yl, —COR 1b  or OR;    R is hydrogen, alkyl of 1-6 carbon atoms, —COR 1 , —(CH 2 ) n CO 2 R 1 , —CH(R 1a )CO 2 R 1 , —SO 2 R 1 , —(CH 2 ) m CH(OH)CO 2 R 1 , —(CH 2 ) m COCO 2 R 1 , —(CH 2 ) m CH═CHCO 2 R 1 , or —(CH 2 ) m O(CH 2 ) o CO 2 R 1 ;    R 1  is hydrogen, alkyl of 1-6 carbon atoms, aralkyl of 6-12 carbon atoms, aryl, or CH 2 CO 2 R 1′ ;    R 1′  is hydrogen or alkyl of 1-6 carbon atoms    E is S, SO, SO 2 , O, or NR 1c ;    X is hydrogen, halogen, alkyl of 1-6 carbon atoms, alkenyl of 2-7 carbon atoms, CN, aryl, aralkyl of 6-12 carbon atoms, hydroxyalkyl of 1-6 carbon atoms, hydroxyaralkyl of 6-12 carbon atoms, perfluoroalkyl of 1-6 carbon atoms, alkoxy of 1-6 carbon atoms, aryloxy; arylalkoxy, nitro, amino, NR 2 R 2a , NR 2 COR 2a , cycloalkylamino of 3-8 carbon atoms, morpholino, alkylsulfanyl of 1-6 carbon atoms, arylsulfanyl, pyridylsulfanyl, 2-N,N-dimethylaminoethyl-sulfanyl, —OCH 2 CO 2 R 2b  or —COR 2c ;    Y is hydrogen, halogen, alkyl of 1-6 carbon atoms, aryl, aralkyl of 6-12 carbon atoms, hydroxyalkyl of 1-6 carbon atoms, hydroxyaralkyl of 6-12 carbon atoms, —OR 3 , SR 3 , NR 3 R 3a , —COR 3b , morpholine or piperidine;    R 1a , R 1c , R 2 , R 2a R 3 , R 3a  are each, independently, hydrogen, alkyl of 1-6 carbon atoms, aralkyl of 6-12 carbon atoms, or aryl;    R 1b  is alkyl of 1-6 carbon atoms or aryl;    R 2b  is hydrogen, alkyl of 1-6 carbon atoms;    R 2c  and R 3b  are each, independently, alkyl of 1-6 carbon atoms, aryl, or aralkyl of 6-12 carbon atoms;    C is hydrogen, halogen or OR 4 ;    R 4  is hydrogen, alkyl of 1-6 carbon atoms, —CH(R 5 )W, —C(CH 3 ) 2 CO 2 R 6 , 5-thiazolidine-2,4-dione, —CH(R 7 )(CH 2 ) m CO 2 R 6 , —COR 6 , —PO 3 (R 6 ) 2 , —SO 2 R 6 , —(CH 2 ) p CH(OH)CO 2 R 6 , —(CH 2 ) p COCO 2 R 6 , —(CH 2 ) p CH═CHCO 2 R 6 , or —(CH 2 ) p O(CH 2 ) q CO 2 R 6 ;    R 5  is hydrogen, alkyl of 1-6 carbon atoms, aralkyl of 6-12 carbon atoms, aryl, —CH 2 (1H-imidazol-4-yl), —CH 2 (3-1H-indolyl), —CH 2 CH 2 (1,3-dioxo-1,3-dihydro-isoindol-2-yl), —CH 2 CH 2 (1-oxo-1,3-dihydro-isoindol-2-yl), —CH 2 (3-pyridyl), —CH 2 CO 2 H, or —(CH 2 ) n G;    G is NR 6a R 7a , NR 6a COR 7a ,                          W is CO 2 R 6 , CONH 2 , CONHOH, CN, CONH(CH 2 ) 2 CN, 5-tetrazole, —PO 3 (R 6 ) 2 , —CH 2 OH, —CONR 6b CHR 7b , —CH 2 NR 6b CHR 7b CO 2 R 6 , —CH 2 OCHR 7b CO 2 R 6 —CH 2 Br, or —CONR 6b CHR 7b CO 2 R 6 ;    R 6 , R 6a , R 7 , R 7a  are each, independently, is hydrogen, alkyl of 1-6 carbon atoms, or aryl;    R 6b  is hydrogen or —COR 6c ;    R 6c  is alkyl of 1-6 carbon atoms or aryl;    R 7b  is hydrogen, alkyl of 1-6 carbon atoms, or hydroxyalkyl of 1-6 carbon atoms;    Z 1  and Z 2  are each, independently, hydrogen, halogen, CN, alkyl of 1-6 carbon atoms, aryl, aralkyl of 6-12 carbon atoms, cycloalkyl of 3-8 carbon atoms, nitro, amino, —NR 1 R 1a , —NR 1 COR 1a , cycloalkylamino of 3-8 carbon atoms, morpholino, or OR 8 , or Z 1  and Z 2  may be taken together as a diene unit having the formula —CH═CR 9 —CR 10 ═CR 11 —;    R 8  is hydrogen, alkyl of 1-6 carbon atoms, or aryl;    R 9 , R 10 , and R 11  are each, independently, hydrogen, alkyl of 1-6 carbon atoms, aryl, halogen, hydroxy, or alkoxy of 1-6 carbon atoms    m is 1 to 4    n is 1 or 2;    p is 1 to 4;    q is 1 to 4;    or a pharmaceutically acceptable salt thereof; and    c) optionally, a pharmaceutically effective amount of a sulfonylurea agent, or a pharmaceutically acceptable salt form thereof.    
     
     
         2 . The method of  claim 1  wherein the PTPase inhibiting compound is as defined in  claim 1 , wherein: 
 Ar is B  
                     
 A is hydrogen or halogen  
 B and D are each, independently, hydrogen, halogen, CN, alkyl of 1-6 carbon atoms, aryl, aralkyl of 6-12 carbon atoms, branched alkyl, cycloalkyl of 3-8 carbon atoms, nitro or OR;  
 R is hydrogen or alkyl of 1-6 carbon atoms;  
 E is S, or O;  
 X is hydrogen, halogen, alkyl of 1-6 carbon atoms, CN, perfluoroalkyl of 1-6 carbon atoms, alkoxy of 1-6 carbon atoms, aryloxy; arylalkoxy, nitro, amino, NR 2 R 2a , NR 2 COR 2a , cycloalkylamino, morpholino, alkylsulfanyl of 1-6 carbon atoms, arylsulfanyl, pyridylsulfanyl, or 2-N,N-dimethylaminoethylsulfanyl;  
 R 1 , R 1a , R 2 , R 2a , R 3 , and R 3a  are each, independently, hydrogen, alkyl of 1-6 carbon atoms, aralkyl of 6-12 carbon atoms, or aryl;  
 Y is hydrogen, halogen, OR 3 , SR 3 , NR 3 R 3a , or morpholine;  
 C is hydrogen, halogen, or OR 4 ;  
 R 4  is hydrogen, alkyl of 1-6 carbon atoms, —CH(R 5 )W, —C(CH 3 ) 2 CO 2 R 6 , 5-thiazolidine-2,4-dione, —CH(R 7 )(CH 2 ) m CO 2 R 6 , —COR 6 , —PO 3 (R 6 ) 2 , —SO 2 R 6 , —(CH 2 ) p CH(OH)CO 2 R 6 , —(CH 2 ) p COCO 2 R 6 , —(CH 2 ) p CH═CHCO 2 R 6 , —(CH 2 ) p O(CH 2 ) q CO 2 R 6 ;  
 R 5  is hydrogen, alkyl of 1-6 carbon atoms, aralkyl of 6-12 carbon atoms, aryl, —CH 2 (1H-imidazol-4-yl), —CH 2 (3-1H-indolyl), —CH 2 CH 2 (1,3-dioxo-1,3-dihydro-isoindol-2-yl), —CH 2 CH 2 (1-oxo-1,3-dihydro-isoindol-2-yl), or —CH 2 (3-pyridyl);  
 W is CO 2 R 6 , —CONH 2 , —CONHOH, 5-tetrazole, or —CONR 6b CHR 7b CO 2 R 6 ;  
 R 6 , R 6a , R 6b , R 7 , R 7a , and R 7b  are each, independently, hydrogen, alkyl of 1-6 carbon atoms, or aryl;  
 Z 1  and Z 2  are each, independently, hydrogen, halogen, CN, alkyl of 1-6 carbon atoms, aryl, aralkyl of 6-12 carbon atoms, cycloalkyl of 3-8 carbon atoms, nitro, amino, —NR 1 R 1a , —NR 1 COR 1a , cycloalkylamino of 3-8 carbon atoms, morpholino, or OR 8 , or Z 1  and Z 2  may be taken together as a diene unit having the formula —CH═CR 9 —CR 10 ═CH—;  
 R 9  and R 10  are each, independently, hydrogen, or alkyl of 1-6 carbon atoms;  
 p is 1 to 4;  
 q is 1 to 4;  
 or a pharmaceutically acceptable salt thereof.  
 
     
     
         3 . The method of  claim 2  wherein the PTPase inhibiting compound is defined in  claim 2 , wherein 
 A is hydrogen;  
 B and D are each, independently, halogen, alkyl of 1-6 carbon atoms, aryl, aralkyl of 6-12 carbon atoms, or cycloalkyl of 3-8 carbon atoms;  
 E is S or O;  
 X is hydrogen, halogen, alkyl of 1-6 carbon atoms, perfluoroalkyl of 1-6 carbon atoms, CN, alkoxy of 1-6 carbon atoms, aryloxy, arylalkoxy of 6-12 carbon atoms, arylsulfanyl;  
 Y is hydrogen, —NR 1 R 2 , or morpholine;  
 R 1  and R 2  are each, independently, hydrogen or alkyl of 1-6 carbon atoms, aralkyl of 6-12 carbon atoms, or aryl;  
 C is OR 4 ;  
 R 4  is hydrogen, alkyl of 1-6 carbon atoms, —CH(R 5 )W, or 5-thiazolidine-2,4-dione;  
 R 5  is hydrogen, alkyl of 1-6 carbon atoms, aralkyl of 6-12 carbon atoms, aryl, —CH 2 (3-1H-indolyl), —CH 2 CH 2 (1,3-dioxo-1,3-dihydro-isoindol-2-yl), or —CH 2 CH 2 (1-oxo-1,3-dihydro-isoindol-2-yl);  
 W is —CO 2 R 6 , —CONH 2 , —CONHOH, 5-tetrazole, —PO 3 (R 6 ) 2 , or —CONR 6 CHR 6 CO 2 R 6 ;  
 R 6  is hydrogen or alkyl of 1-6 carbon atoms;  
 Z 1  and Z 2  are taken together as a diene unit having the formula —CH═CH—H═CH—;  
 or a pharmaceutically acceptable salt thereof.  
 
     
     
         4 . The method of  claim 1  wherein the PTPase inhibiting compound is (2R)-2-[4-(9-Bromo-2,3-dimethyl-naptho[2,3-b]thiophen-4-yl)-2,6-dimethyl-phenoxy]-3-phenyl-propionic acid, or a pharmaceutically acceptable salt form thereof.  
     
     
         5 . The method of  claim 1  wherein the PTPase inhibiting compound is selected from the group of: 
 (R)-2-[2,6-dibromo-4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-phenoxy]-3-phenyl-propionic acid;  
 (R)-2-[2-bromo-4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-6-ethyl-phenoxy]-3-phenyl-propionic acid;  
 (R)-2-[4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2,6-dimethyl-phenoxy]-3-phenyl-propionic acid;  
 (R)-2-[4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2-fluoro-phenoxy]-3-phenyl-propionic acid;  
 [4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2,6-diisopropyl-phenoxy]-acetic acid;  
 or a pharmaceutically acceptable salt form thereof.  
 
     
     
         6 . The method of  claim 1  wherein the PTPase inhibiting compound is selected from the group of: 
 (R)-2-[2-bromo-4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-6-sec-butyl-phenoxy]-3-phenyl-propionic acid;  
 (R)-2-[2-bromo-4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-6-isopropyl-phenoxy]-3-phenyl-propionic acid;  
 (R)-2-[2-bromo-4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2-cyclopentyl-phenoxy]-3-phenyl-propionic acid;  
 (R)-2-[4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-6-isopropyl-phenoxy]-3-phenyl-propionic acid;  
 (R)-2-[4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2-cyclopentyl-phenoxy]-3-phenyl-propionic acid; or a pharmaceutically acceptable salt thereof.  
 
     
     
         7 . The method of  claim 1  wherein the PTPase inhibiting compound is selected from the group of: 
 (R)-2-[2,6-dibromo-4-(2,3-dimethyl-9-phenylsulfanyl-naphtho[2,3-b]thiophen-4-yl)-phenoxy]-3-phenyl-propionic acid;  
 (R)-2-[2,6-dibromo-4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-phenoxy]-4-phenyl-butyric acid;  
 (S)-2-[2,6-dibromo-4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-phenoxy]-4-phenyl-butyric acid;  
 2-[2,6-dibromo-4-(9-bromo-3-methyl-2-morpholin-4-ylmethyl-naphtho[2,3-b]thiophen-4-yl)-phenoxy]-3-phenyl-propionic acid;  
 (R)-2-[2,6-dibromo-4-(2,3-dimethyl-9-phenylsulfanyl-naphtho[2,3-b]thiophen-4-yl)-phenoxy]-propionic acid; or a pharmaceutically acceptable salt thereof.  
 
     
     
         8 . The method of  claim 1  wherein the PTPase inhibiting compound is selected from the group of: 
 [2-bromo-4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2-nitro-phenoxy]-3-phenyl-propionic acid;  
 2,6-dibromo-4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-phenol;  
 2-bromo-4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-6-nitro-phenol;  
 (R)-2-[2,6-dibromo-4-(9-bromo-2-diethylaminomethyl-3-methyl-naphtho[2,3-b]thiophen-4-yl)-phenoxy]-3-phenyl-propionic acid;  
 (R)-2-[2,6-dibromo-4-(2,3-dimethyl-naphtho[2,3-b]furan-4-yl)-phenoxy]-3-phenyl-propionic acid; or a pharmaceutically acceptable salt thereof.  
 
     
     
         9 . The method of  claim 1  wherein the PTPase inhibiting compound is selected from the group of: 
 (2R)-2-[4-9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2,6-diisopropyl-phenoxy]-3-phenyl-propionic acid,  
 (R)-2-[4-(9-bromo-2-,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2,6-diethyl-phenoxy]-3-phenyl-propionic acid;  
 {(2R)-2-[4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2,6-dimethyl-phenoxy]-3-phenyl-propionylamino}-acetic acid;  
 {(2R)-2-[4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2,6-diethyl-phenoxy]-3-phenyl-propionylamino}-acetic acid;  
 (2R)-2-[4-(9-Bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-phenoxy]-3-phenyl-propionic acid; or a pharmaceutically acceptable salt thereof.  
 
     
     
         10 . The method of  claim 1  wherein the PTPase inhibiting compound is selected from the group of: 
 (2S)-2-[4-(9-Bromo-2-,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2,6-dimethyl-phenoxy]-3-phenyl-propionic acid;  
 {(2R)-2-[4-(2,3-Dimethyl-naphtho[2,3-b]thiophen-4-yl)-2,6-diethyl-phenoxy]-3-phenyl-propionylamino}-acetic acid;  
 (R)-2-[4-(9-Bromo-2-,3-dimethyl-naphtho[2,3-b]furan-4-yl)-2,6-diethyl-phenoxy]-3-phenyl-propionic acid;  
 (R)-2-[2-Cyclopentyl-4-(2-,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-phenoxy]-propionic acid;  
 (R)-2-[4-(9-Bromo-2-,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2-cyclopentyl-phenoxy]-propionic acid; or a pharmaceutically acceptable salt thereof.  
 
     
     
         11 . The method of  claim 1  wherein the PTPase inhibiting compound is selected from the group of: 
 (R)-2-[4-(2-,3-Dimethyl-naphtho[2,3-b]thiophen-4-yl)-2-ethyl-phenoxy]-3-phenyl-propionic acid;  
 2-Bromo-4-(2-,3-dimethyl-naphtho[2,3-b]furan-4-yl)-6-ethyl-phenol;  
 (R)-2-[2-Bromo-4-(2-,3-dimethyl-naphtho[2,3-b]furan-4-yl)-6-ethyl-phenoxy]-3-phenyl-propionic acid;  
 (R)-2-[4-(9-Bromo-2-,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2-propyl-phenoxy]-3-phenyl-propionic acid;  
 (2R)-2-[4-(9-Bromo-2-diethylaminomethyl-3-methyl-naphtho[2,3-b]thiophen-4-yl)-2,6-diisopropyl-phenoxy]-3-phenyl-propionic acid;  
 or a pharmaceutically acceptable salt thereof.  
 
     
     
         12 . The method of  claim 1  wherein the biguanide agent is metformin, or a pharmaceutically acceptable salt thereof.  
     
     
         13 . The method of  claim 1  wherein the optional sulfonylurea agent is selected from group of glyburide, glyburide, glipizide, glimepiride, chlorpropamide, tolbutamide, or tolazamide, or a pharmaceutically acceptable salt form thereof.  
     
     
         14 . A method of treating metabolic disorders mediated by insulin resistance or hyperglycemia in a mammal, the method comprising administering to a mammal in need thereof a pharmaceutically effective amount of a pharmaceutically effective amount of a PTPase inhibiting compound, as described in  claim 1 , a pharmaceutically effective amount of a biguanide agent and, optionally, a sulfonylurea agent and or a pharmaceutically acceptable salt thereof.  
     
     
         15 . The method of  claim 14  wherein the biguanide agent is metformin, or a pharmaceutically acceptable salt thereof.  
     
     
         16 . The method of  claim 14  wherein the optional sulfonylurea agent is selected from group of glyburide, glyburide, glipizide, glimepiride, chlorpropamide, tolbutamide, or tolazamide, or a pharmaceutically acceptable salt form thereof.  
     
     
         17 . The method of  claim 14  wherein the PTPase inhibiting compound is (2R)-2-[4-(9-Bromo-2,3-dimethyl-naptho[2,3-b]thiophen-4-yl)-2,6-dimethyl-phenoxy]-3-phenyl-propionic acid, or (R)-2-[2,6-Dibromo-4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-phenoxy]3-phenyl-propionic acid, or (R)-2-[4-(9-Bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2,6-diethyl-phenoxy]-3-phenyl-propionic acid, or a pharmaceutically acceptable salt form thereof.  
     
     
         18 . A method of modulating blood glucose levels in a mammal, the method comprising administering to a mammal in need thereof a pharmaceutically effective amount of a pharmaceutically effective amount of a PTPase inhibiting compound, as described in  claim 1 , a pharmaceutically effective amount of a biguanide agent and, optionally, a sulfonylurea agent and or a pharmaceutically acceptable salt thereof.  
     
     
         19 . The method of  claim 18  wherein the biguanide agent is metformin, or a pharmaceutically acceptable salt thereof.  
     
     
         20 . The method of  claim 18  wherein the optional sulfonylurea agent is selected from group of glyburide, glyburide, glipizide, glimepiride, chlorpropamide, tolbutamide, or tolazamide, or a pharmaceutically acceptable salt form thereof.  
     
     
         21 . The method of  claim 18  wherein the PTPase inhibiting compound is (2R)-2-[4-(9-Bromo-2,3-dimethyl-naptho[2,3-b]thiophen-4-yl)-2,6-dimethyl-phenoxy]-3-phenyl-propionic acid, or (R)-2-[2,6-Dibromo-4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-phenoxy]3-phenyl-propionic acid, or (R)-2-[4-(9-Bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-2,6-diethyl-phenoxy]-3-phenyl-propionic acid, or a pharmaceutically acceptable salt form thereof.  
     
     
         22 . A pharmaceutical composition comprising a pharmaceutically acceptable carrier or excipient and: 
 a) a pharmaceutically effective amount of metformin, or a pharmaceutically acceptable salt thereof; and    b) a pharmaceutically effective amount of a PTPase inhibiting compound of  claim 1 , or a pharmaceutically acceptable salt form thereof; and    c) optionally, a pharmaceutically effective amount of a sulfonylurea agent.    
     
     
         23 . The pharmaceutical composition of  claim 22  comprising a pharmaceutically acceptable carrier or excipient and: 
 a) a pharmaceutically effective amount of metformin, or a pharmaceutically acceptable salt thereof; and  
 b) a pharmaceutically effective amount of (2R)-2-[4-(9-Bromo-2,3-dimethyl-naptho[2,3-b]thiophen-4-yl)-2,6-dimethyl-phenoxy]-3-phenyl-propionic acid, or (R)-2-[2,6-Dibromo-4-(9-bromo-2,3-dimethyl-naphtho[2,3-b]thiophen-4-yl)-phenoxy]3-phenyl-propionic acid, or (R)-2-[4-(9-Bromo-2,3-dimethyl-naphtho[2,3-b]-thiophen-4-yl)-2,6-diethyl-phenoxy]-3-phenyl-propionic acid, or a pharmaceutically acceptable salt form thereof; and  
 c) optionally, a pharmaceutically effective amount of a sulfonylurea agent selected from the group of glyburide, glyburide, glipizide, glimepiride, chlorpropamide, tolbutamide, or tolazamide, or a pharmaceutically acceptable salt form thereof.