Diabetes mellitus, type 2, poorly controlled with oral agents: Combined treatment with insulin and oral hypoglycaemic agents
DISEASE INTERVENTION COMPARISON RESULTS
Arch Intern Med. 2009 Mar 23;169(6):616-25 Randomized Controlled Trial
IN diabetes mellitus, type 2, needing insulin The Use of
adding oral hypoglycemic agents, metformin, to insulin combination
As Treatment, Chronic
Is better Than
insulin monotherapy alone
To reduce macrovascular compications (NNT 16) but not microvascular complications.
N Engl J Med. 2007 Oct 25;357(17):1716-30 Randomized Controlled Trial
IN diabetes mellitus, type 2, needing insulin The Use of
addition of biphasic or prandial rapid (aspart) insulin to oral agents
As Treatment, Chronic
Is better Than
addition of basal slow (detemir) insulin to oral agents
To improve glycaemic control: 7.2% in prandial group VS 7.6% in the basal group, but increased hypoglycaemia and weight gain.
Diabetes Care. 2005 Feb;28(2):254-9 Randomized Controlled Trial
IN diabetes mellitus, type 2, needing insulin The Use of
long acting insulin (bedtime glargine insulin (Lantus-TM)) plus oral hypoglycemic agents combination
As Treatment, Chronic
Is better Than
insulin monotherapy (mixed NPH/rapid twice daily)
To control glycaemia (more patients reaching HgA1c < 7%: 46% combined treatment VS 29% insulin alone) and avoid hypoglycaemia.
Cochrane Database Syst Rev. 2004 Oct 18;(4):CD003418 Systematic Review, Cochrane Review
IN diabetes mellitus, type 2, needing insulin The Use of
medium-long acting insulin (bedtime NPH) plus oral hypoglycemic agents combination
As Treatment, Chronic
Is equal Than
medium-long acting insulin monotherapy (NPH once or twice daily)
To control glycaemia and avoid hypoglycaemia. Better to control weight if metformin is used (less weight gain). Mortality or associated morbility (cardiac, renal, ocular...) were not evaluated.