Insulin v. Triple oral therapy for DM

Diabetes Care 12/23/09 –   “Insulin is the most effective hypoglycemic agent in our treatment armamentarium and is now recommended by the American Diabetes Association (ADA) guidelines as the second agent added after metformin” (FTA). Despite this fact (or because some of us were unaware of this guideline), physicians often prefer to max out that second and third oral medication before turning to insulin. An article in Diabetes Care looks at a comparison between a three drug regimen and insulin + metformin for newly diagnosed DM. The study compared 2 groups of 29 subjects that were newly diagnosed diabetics (not a very large study). All patients had a 3 month lead-in with insulin (novolog 70/30 bk, ln) and metformin. The lead-in ensured that all subjects had controlled blood sugar when starting the comparison phase, and all were exposed to insulin administration. Subjects were then randomized to receive metformin + glyburide + pioglitazone or to continue metformin and insulin. Groups were compared on A1C, Quality of Life, and treatment satisfaction. They found that A1C was similar in both treatment groups. But I think the other endpoints were just as, if not more important to the relevance of the study.   Weight gain, quality of life, and compliance are major factors that sway physician and patient choices on when to start insulin. The study showed that the weight difference was not significant in the 2 groups – however looking at the raw numbers w...
Source: Consider The Evidence: Med/Peds Journal Roundup - Category: Internists and Doctors of Medicine Authors: Tags: diabetes Source Type: blogs