Clinical Question Are combination...

Clinical Question

Are combinations of insulin and oral agents more effective than insulin monotherapy in patients with stamp 2 diabetes mellitus?

Evidence-Based Answer

NPH insulin and metformin taken at bedtime appears to be the most numerous favorable combination studied, but this conclusion is based in succession poor-quality, inconsistent studies that measure disease-oriented issues There are no data in succession the effect of these mix with drugs combinations on patient-oriented outcomes.

Practice Pointers

Goudswaard and colleagues identified 20 randomized controll trials (RCTs) with a total of 1811 patients. The RCT included 28 comparisons of insulin monotherapy with a combination of insulin and a sulfonylurea, metformin, or the couple About one half of the patients were women The mean age was 60 years, and patients had sign 2 diabetes for a mean of 10 years. None of the studies assessed diabetic complications, diabetes-related mortality, or total mortality. In the United Kingdom Prospective Diabetes subject of attention treatment of overweight patients with insulin or sulfonylureas had no import on individual or aggregate microvascular or macrovascular results (36.8 versus 38.9 events by 1,000 patient years). (1,2)

The identified RCT were fair quality, with a mean score of 28 upon a seven-point quality scale. in the greatest degree did not clearly describe to what degree patients were allocated to treatment clusters and 11 RCTs did not blind patients, physicians, or living bodys evaluating outcomes. A variety of regimens were compared, and consequence s were combined where appropriate. Differences between insulin monotherapy and combination approaches generally were small and inconsistent. The combination of an oral agent and insulin typically riseed in a slightly lower hemoglobin A1C horizontal (0.1 to 0.4 percent), a difference that is unlikely to be clinically important. Patients taking the combination of insulin and metformin were les likely to gain weight than those taking insulin alone, unless this combination was examined solely in a single, relatively small RCT There was no difference between assign places tos in the likelihood of symptomatic hypoglycemia.

Goudswaard AN, et al. Insulin monotherapy versus combinations of insulin with oral hypoglycaemic agents in patients with model 2 diabetes mellitus. Cochrane Database Syst Rev 2004;(4):CD003418

REFERENCES

(1) Intensive blood-glucose have charge of with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with original 2 diabetes (UKPDS 33). UK Prospective Diabetes thought (UKPDS) Group [published correction appears in Lancet 1999;354:602] Lancet 1998;352:837-53

(2) Shaughnessy AF, Slawson DC What happened to the valid POEMs? A observe of review articles on the treatment of model 2 diabetes. BMJ 2003;327:266.

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