title: A real world comparison of sulfonylurea and insulin vs. incretin-based treatments in patients not controlled on prior metformin monotherapy.
abstract: OBJECTIVE
  Metformin is the first line drug for patients diagnosed with type-2 diabetes; however, the impact of different treatment escalation strategies after metformin failure has thus far not been investigated in a real world situation. The registry described herein goes some way to clarifying treatment outcomes in such patients.
  
  
  METHODS
  DiaRegis is a multicentre registry including 3,810 patients with type-2 diabetes. For the present analysis we selected patients being treated with metformin monotherapy at baseline (n = 1,373), with the subsequent addition of incretin-based drugs (Met/Incr; n = 783), sulfonylureas (Met/SU; n = 255), or insulin (n = 220).
  
  
  RESULTS
  After two years 1,110 of the initial 1,373 patients had a complete follow-up (80.8%) and 726 of these were still on the initial treatment combination (65.4%). After treatment escalation, compared to Met/Incr (n = 421), Met/SU (n = 154) therapy resulted in a higher HbA1c reduction vs. baseline (-0.6 ± 1.4% vs. -0.5 ± 1.0%; p = 0.039). Insulin (n = 151) resulted in a stronger reduction in HbA1c (-0.9 ± 2.0% vs. -0.5 ± 1.0%; p = 0.003), and fasting plasma glucose (-24 ± 70 mg/dl vs. -19 ± 42 mg/dl; p = 0.001), but was associated with increased bodyweight (0.8 ± 9.0 kg vs. -1.5 ± 5.0 kg; p = 0.028). Hypoglycaemia rates (any with or without help and symptoms) were higher for patients receiving insulin (Odds Ratio [OR] 8.35; 95% Confidence Interval [CI] 4.84-14.4) and Met/SU (OR 2.70; 95% CI 1.48-4.92) versus Met/Incr. While there was little difference in event rates between Met/Incr and Met/SU, insulin was associated with higher rates of death, major cardiac and cerebrovascular events, and microvascular disease.
  
  
  CONCLUSIONS
  Taking the results of DiaRegis into consideration it can be concluded that incretin-based treatment strategies appear to have a favourable balance between glycemic control and treatment emergent adverse effects.
authors: Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Bremser Strasse 79, 67063, Ludwigshafen, Germany. gitta@klilu.de.|Herzzentrum Ludwigshafen, Medizinische Klinik B, Kardiologie, Ludwigshafen, Germany. gitta@klilu.de.
authors: Anselm K
authors: AK
authors: Gitt
authors: Institut für Pharmakologie und präventive Medizin, Mahlow, Germany. peter.bramlage@ippmed.de.
authors: Peter
authors: P
authors: Bramlage
authors: Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Bremser Strasse 79, 67063, Ludwigshafen, Germany. schneider@herzinfarktfoschung.de.
authors: Steffen
authors: S
authors: Schneider
authors: Stiftung, ''Der herzkranke Diabetiker'' in der Deutschen Diabetes Stiftung, Bad Oeynhausen, Germany. diethelm.tschoepe@ruhr-uni-bochum.de.|Herz- und Diabeteszentrum Nordrhein- Westfalen, Universitätsklinik der Ruhr Universität Bochum, Bad Oeynhausen, Germany. diethelm.tschoepe@ruhr-uni-bochum.de.
authors: Diethelm
authors: D
authors: Tschöpe
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D054795:Incretins / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008687:Metformin / Q000008:administration & dosage*; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D013453:Sulfonylurea Compounds / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D054795:Incretins; D007328:Insulin; D013453:Sulfonylurea Compounds; D008687:Metformin
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