[The combination of insulin and metformin in obese patients with type-2 diabetes mellitus].
OBJECTIVE
Principal: to show that the addition of metformin to insulin treatment in type-2 DM obese patients with poor metabolic control (HbA1c > 7.5%) causes a 50% increase after one year in the number of patients with acceptable (HbA1c < or = 7.5%) or good (HbA1c < 6.5%) control, and to determine how many patients reduced their HbA1c by a point. Secondary: to determine the relationship between the BMI at the start of treatment and the difference between HbA1c values before and after treatment.


METHODS
Quasi-experimental before-and-after intervention study.


METHODS
Diabetes clinic at the San Carlos Hospital, consisting of patients referred from primary care.


METHODS
31 obese people with type-2 DM and with poor metabolic control (HbA1c > 7.5%) in spite of insulin treatment were chosen by consecutive sampling as they attended for consultation. Three people left due to their intolerance of metformin.


METHODS
Metformin was added progressively over a year in total doses of 1.7 mg. All those parameters considered in diabetes control were measured, the main criterion of evaluation being the HbA1c figures.


RESULTS
Patients with poor metabolic control changed from 100% at the start of the study to 42.9% after a year (p = 0.0000). There was a 1.75% mean reduction of HbA1c. 78.57% of patients reduced their HbA1c by a point. The relationship between the BMI before the start of treatment and the HbA1c difference at the start and end gave a Pearson's correlation coefficient of r = -0.39 (p = 0.04).


CONCLUSIONS
Adding metformin to the treatment of obese type-2 DM patients with poor metabolic control and on insulin treatment improved their control.
Sánchez-Barba Izquierdo
M I
MI
Centro de Salud Espronceda, Madrid. pir@mx3.redetebs.es
Ibarra Rueda
J M
JM
Ruiz de Adana Pérez
R
R
D000419:Albuminuria / Q000652:urine; D001786:Blood Glucose / Q000032:analysis / Q000187:drug effects; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008687:Metformin / Q000008:administration & dosage*; D008875:Middle Aged; D009765:Obesity; D013997:Time Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin