Efficacy of metformin-based oral antidiabetic drugs is not inferior to insulin glargine in newly diagnosed type 2 diabetic patients with severe hyperglycemia after short-term intensive insulin therapy.
BACKGROUND
Insulin therapy should be strongly considered in newly diagnosed type 2 diabetic (T2D) patients with severe hyperglycemia. However, whether insulin be continued or patients switched to an oral antidiabetic drug (OAD) after short-term intensive insulin therapy (ITT) is not clear.


METHODS
After ITT for 10-14 days, 47 patients were randomized into either a glargine (n = 21) or metformin-based OAD (n = 26) group for a 6-month intervention. After these 6 months, patients in the glargine group were switched to metformin-based OAD therapy, whereas treatment in the OAD group was unchanged. Patients were followed-up for another 6 months.


RESULTS
At the end of the 6-month intervention, HbA1c was similarly reduced in both the glargine (from 11.81 ± 1.70% to 6.48 ± 0.79%; P < 0.001) and OAD (from 11.71 ± 1.89% to 6.16 ± 0.52%; P < 0.001) groups. At the end of 12 months, HbA1c was at comparable and near optimal levels in both groups. Similar increases were seen in homeostatic model assessment of β-cell function in the two groups after 6 months. There were no significant differences between the two groups in insulin sensitivity improvement, hypoglycemic episodes, weight change, treatment satisfaction and quality of life after the 6-month intervention.


CONCLUSIONS
The effects of metformin-based OAD therapy on glycemic control and improvements in β-cell function are not inferior to glargine in newly diagnosed T2D patients with severe hyperglycemia after short-term ITT. Considering the superiority of metformin in terms of safety, cost, and convenience, metformin-based OAD therapy is strongly recommended for these patients.
Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Qingfeng
Q
Cheng
Shumin
S
Yang
Changhong
C
Zhao
Zhihong
Z
Wang
Zhengping
Z
Feng
Rong
R
Li
Peng
P
Ye
Suhua
S
Zhang
Huacong
H
Deng
Bo
B
Zhou
Jian
J
Long
Lilin
L
Gong
Hua
H
Qing
Cheng
C
Luo
Qifu
Q
Li
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002681:China; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000627:therapeutic use*; D050417:Insulin-Secreting Cells / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008687:Metformin / Q000008:administration & dosage*; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D008687:Metformin
glargine; intensive insulin therapy; metformin; type 2 diabetes mellitus; 关键词：甘精胰岛素，胰岛素强化治疗，二甲双胍，2型糖尿病