Impact of concomitant oral glucose-lowering medications on the success of basal insulin titration in insulin-naïve patients with type 2 diabetes
- Basal insulin treatment for type 2 diabetes is usually initiated on a background of oral glucose-lowering medications (OGLM). We wanted to examine the influence of various OGLMs on fasting plasma glucose (FPG) and hemoglobin \(A_{1c}\) (\(HbA_{1c}\)) values achieved after titration. A PubMed literature search retrieved 42 publications (clinical trials introducing basal insulin in 17 433 insulin-naïve patients with type 2 diabetes on a defined background of OGLM) and reporting FPG, \(HbA_{1c}\), target achievement, hypoglycemic events, and insulin doses. 60 individual study arms were grouped by OGLM (combinations) allowed during the titration process: (a) metformin only; (b) sulfonylureas only; (c) metformin and sulfonylureas; or (d) metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors. For all OGLM categories, weighted means and SD were calculated for baseline and end-of-treatment FPG, \(HbA_{1c}\), target achievement, incidence of hypoglycemic events, and insulin doses. Primary end point was a difference in FPG after titration between OGLM categories. Statistics: analysis of variance and post hoc comparisons. Sulfonylureas, alone or in combination with metformin, impair the titration of basal insulin (insulin doses 30%–40% lower, more hypoglycemic episodes), thus leading to poorer final glycemic control (p<0.05 for FPG and \(HbA_{1c}\) after titration). Conversely, adding a DPP-4 inhibitor to metformin is superior to metformin alone (p<0.05 for FPG and \(HbA_{1c}\) achieved) in patients with type 2 diabetes initiating basal insulin therapy. In conclusion, OGLM are a major determinant of the success of basal insulin therapy. Sulfonylureas impair, while DPP-4 inhibitors (added to metformin) may facilitate the achievement of ambitious fasting glucose targets. PROSPERO registration number CRD42019134821.
Author: | Dominik WollenhauptORCiDGND, Jannik WoltersGND, Mirna Safia Abd El AzizGND, Michael NauckORCiDGND |
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URN: | urn:nbn:de:hbz:294-108344 |
DOI: | https://doi.org/10.1136/bmjdrc-2022-003296 |
Parent Title (English): | BMJ Open diabetes research & care |
Subtitle (English): | a systematic analysis |
Publisher: | BMJ Publishing Group |
Place of publication: | London |
Document Type: | Article |
Language: | English |
Date of Publication (online): | 2024/02/22 |
Date of first Publication: | 2023/06/11 |
Publishing Institution: | Ruhr-Universität Bochum, Universitätsbibliothek |
Tag: | Open Access Fonds |
Volume: | 11 |
Issue: | 4, Article e003296 |
First Page: | e003296-1 |
Last Page: | e003296-11 |
Note: | Article Processing Charge funded by the Deutsche Forschungsgemeinschaft (DFG) and the Open Access Publication Fund of Ruhr-Universität Bochum. |
Institutes/Facilities: | St. Josef-Hospital Bochum, Medizinische Klinik I |
Dewey Decimal Classification: | Technik, Medizin, angewandte Wissenschaften / Medizin, Gesundheit |
open_access (DINI-Set): | open_access |
Licence (English): | Creative Commons - CC BY-NC 4.0 - Attribution-NonCommercial 4.0 International |