An analysis of early insulin glargine added to metformin with or without sulfonylurea: impact on glycaemic control and hypoglycaemia

作者：Fonseca V^*; Gill J; Zhou R; Leahy J

来源：Diabetes, Obesity and Metabolism, 2011, 13(9): 814-822.

DOI：10.1111/j.1463-1326.2011.01412.x

• basal insulin therapy
• insulin glargine
• metformin
• oral antidiabetic drugs
• sulfonylurea
• type 2 diabetes mellitus

Aim: To evaluate the benefits of initiating insulin at an earlier versus later treatment stage, and regimens with/without sulfonylurea (SU).
Methods: Pooled analysis of 11 prospective randomized clinical trials, including 2171 adults with uncontrolled type 2 diabetes initiating insulin glargine following a specific titration algorithm. Clinical outcomes were glycated haemoglobin Ale (HbA1c) reduction, per cent achieving HbA1c <= 7.0%, weight gain and hypoglycaemic events. Statistical analysis compared outcomes 24 weeks after basal insulin initiation in patients previously uncontrolled on 0/1 oral antidiabetic drug (CAD) versus 2 OADs, and in patients taking metformin (M) or SU alone or in combination at baseline. A meta-analysis was also conducted.
Results: For the pooled analysis, patients on 0/1 OAD and those on MET monotherapy at baseline had the largest 24-week reductions in HbA1c following the addition of insulin glargine (similar to 0.44 U/kg). Of patients failing MET/SU monotherapy and MET + SU in combination, 68.1, 50.4 and 56.4% achieved HbA1c <= 7.0%, respectively (p = 0.0006). Weight gain was lowest when basal insulin was added to MET. Patients on 0/1 OAD at baseline had significantly less symptomatic hypoglycaemia when basal insulin was added than those on 2 OADs (p = 0.0007). Despite higher insulin closes, those taking MU alone had less hypoglycaemia than those taking SU or MET + SU. Results were confirmed in the meta-analysis.
Conclusion: Adding insulin glargine to MET monotherapy early in treatment Indy provide efficacy/safety benefits over regimens including SU. This may reflect treatment earlier in the disease and supports the inclusion of insulin as a second step in the American Diabetes Association/European Association for the Study of Diabetes treatment algorithm.

• 出版日期2011-9