Insulin 70/30 Mix Plus Metformin Versus Triple Oral Therapy in the Treatment of Type 2 Diabetes After Failure of Two Oral Drugs
Abstract
OBJECTIVE—Subjects (n = 188) with type 2 diabetes and inadequate response to two oral medications (A1C >8.0%) were randomly assigned to treatment with either a third oral medication or an insulin 70/30 mix b.i.d. plus metformin for a comparison of efficacy, safety, and cost. RESEARCH DESIGN AND METHODS—The protocol called for aggressive dose titration to achieve target values of fasting blood glucose (80–120 mg/dl), postprandial glucose (<160 mg/dl), and A1C (<7%). These efficacy parameters were evaluated at weeks 2, 6, 12, and 24 of therapy. If dose adjustments failed to achieve targeted glycemic control, subjects were switched to an alternate therapy. RESULTS—At the end of study (week 24 of therapy), A1C and fasting plasma glucose (FPG) values showed comparable decreases in the two treatment groups. Only 31% (oral therapy) and 32% (insulin plus metformin) of subjects achieved target values of A1C (<7%). A total of 10 of the 98 subjects randomized to triple oral therapy (10.2%) who failed to improve sufficiently were switched to insulin therapy. An additional four subjects dropped out of the oral treatment group due to adverse events felt to be potentially drug related. Only two of the subjects randomized to insulin plus metformin had to be switched to basal-bolus regimens (regular insulin and NPH insulin). Cost analysis determined that insulin plus metformin (mean cost $3.20/day) provided efficacy equal to that of a triple oral drug regimen ($10.40/day). CONCLUSIONS—Insulin 70/30 mix plus metformin was as effective as triple oral therapy in lowering A1C and FPG values. The triple oral regimen was not as cost effective, and a high percentage of subjects (total of 16.3%) did not complete this regimen due to lack of efficacy or side effects.
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Addition of a third oral agent is no more effective in lowering glycemia, and is more costly, than initiating or intensifying insulin.
“Although addition of a third oral agent can be considered, especially if the A1C level is close to target (A1C <8.0%), this approach is usually not preferred, as it is no more effective in lowering glycemia, and is more costly, than initiating or intensifying insulin (91).”
From Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy (2009) · cites this paper as [91]
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TEACHERS' TOPICS Insulin and Oral Antidiabetic Agents
Mehanna, A. S. (2005)
Insulin treatment in type 2 diabetes
Arnedo, J. A., & Tejedor, J. L. (2008)
Insulin: Thoroughly Modern Therapy
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- Authors
- Schwartz, S., Sievers, R., Strange, P., Lyness, W. H., Hollander, P., & For The INS-2061 Study Team
- Affiliations
- Diabetes & Glandular Disease Clinic (US)
- Wells Institute for Health Awareness (US)
- Princeton Junction, New Jersey
- Novo Nordisk Pharmaceuticals, Inc., Princeton, New Jersey
- Baylor University Medical Center (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2003-08-01
- Volume
- 26
- Issue
- 8
- Pages
- 2238-2243
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2003391964
- Cited by
- 117
- References
- 16
- Citations by year
- 2020: 1 · 2019: 2 · 2017: 1 · 2016: 3 · 2015: 4 · 2014: 4 · 2013: 2 · 2012: 3
- FWCI
- 7.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Novo Nordisk
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, metformin, glycemic control, HbA1c, fasting blood glucose, cost-effectiveness, treatment switching, adverse drug reactions
- MeSH terms
- Administration, Oral, Adult, Blood Glucose, Diabetes Mellitus, Type 2, Drug Resistance, Drug Therapy, Combination, Female, Humans, Hypoglycemic Agents, Insulin, Lipids, Male, Metformin, Middle Aged, Drug Costs, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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