title: Clinical inquiries. What is the role of combination therapy (insulin plus oral medication) in type 2 diabetes?
abstract: Combination therapy using insulin plus metformin (Glucophage), a sulfonylurea, or both produces glycemic control comparable with using insulin alone, but there is less weight gain when metformin is used (strength of recommendation [SOR]: B, based on systematic review of randomized controlled trials [RCTs] with some heterogeneity). Combination therapy using insulin and pioglitazone (Actos) reduces glycosylated hemoglobin (Hb A1c) more than either insulin alone or adding pioglitazone to a sulfonylurea, but results in more weight gain (SOR: A, based on RCT). Using insulin glargine (Lantus) in combination therapy produces fewer nocturnal hypoglycemic events than using neutral protamine Hagedorn (NPH) insulin, while producing equivalent Hb A1c reduction (SOR: B, based on RCT). When the HbA1c is high (above 9.0% to 9.5%) on 1 or 2 oral agents, beginning combination therapy is more effective than adding another oral agent (SOR: B, based on subpopulation analysis in RCTs).
authors.affiliation: Valley Family Medicine Residency, Renton, WA, USA.
authors.forename: Staci
authors.initials: S
authors.lastname: Eskesen
authors.forename: Gary
authors.initials: G
authors.lastname: Kelsberg
authors.forename: Kristin
authors.initials: K
authors.lastname: Hitchcock
authors.forename: Vincent
authors.initials: V
authors.lastname: Lo
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008687:Metformin / Q000008:administration & dosage*; D013453:Sulfonylurea Compounds / Q000008:administration & dosage*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds; D008687:Metformin