Insulin-based versus triple oral therapy for newly diagnosed type 2 diabetes

Which is better?

Ildiko Lingvay, Jaime L. Legendre, Polina F. Kaloyanova, Song Zhang, Beverley A Huet, Philip Raskin

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

OBJECTIVE - Early use of insulin after diagnosis of type 2 diabetes is met with resistance because of associated weight gain, hypoglycemia, and fear of decreased compliance and quality of life (QoL). RESEARCH DESIGN AND METHODS - In treatment-naive patients with newly diagnosed type 2 diabetes, insulin and metformin were initiated for a 3-month lead-in period, then patients were randomly assigned to insulin and metformin (insulin group) or metformin, pioglitazone, and glyburide (oral group) for 36 months. Hypoglycemic events, compliance, A1C, weight, QoL, and treatment satisfaction were assessed. RESULTS - Of 29 patients randomly assigned into each group, 83% (insulin group) and 72% (oral group) completed this 3-year study. At study completion, A1C was 6.1 ± 0.6% (insulin group) versus 6.0 ± 0.8% (oral group). Weight increased similarly in both groups (P = 0.09) by 4.47 kg (95% CI 0.89-8.04 kg) (insulin group) and 7.15 kg (95% CI 4.18-10.13 kg) (orals group). Hypoglycemic events did not differ between groups (mild 0.51 event/person-month in the insulin group vs. 0.68 event/person-month in the orals group, P = 0.18 and severe 0.04 event/person-year in the insulin group vs. 0.09 event/person-year in the orals group, P = 0.53). Compliance, QoL, and treatment satisfaction were similar between groups, with 100% of patients randomly assigned to insulin willing to continue such treatment. CONCLUSIONS - When compared with a clinically equivalent treatment regimen, insulin-based therapy is effective and did not cause greater weight gain or hypoglycemia nor decrease compliance, treatment satisfaction, or QoL. Insulin is safe, well-accepted, and effective for ongoing treatment of patients with newly diagnosed type 2 diabetes.

Original languageEnglish (US)
Pages (from-to)1789-1795
Number of pages7
JournalDiabetes Care
Volume32
Issue number10
DOIs
StatePublished - Oct 2009

Fingerprint

Type 2 Diabetes Mellitus
Insulin
Compliance
Therapeutics
Quality of Life
Metformin
pioglitazone
Hypoglycemia
Hypoglycemic Agents
Weight Gain
Weights and Measures
Fear
Research Design

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Insulin-based versus triple oral therapy for newly diagnosed type 2 diabetes : Which is better? / Lingvay, Ildiko; Legendre, Jaime L.; Kaloyanova, Polina F.; Zhang, Song; Huet, Beverley A; Raskin, Philip.

In: Diabetes Care, Vol. 32, No. 10, 10.2009, p. 1789-1795.

Research output: Contribution to journalArticle

@article{22c4a5bc6a9847a381c0b2e4ea8c2e9a,
title = "Insulin-based versus triple oral therapy for newly diagnosed type 2 diabetes: Which is better?",
abstract = "OBJECTIVE - Early use of insulin after diagnosis of type 2 diabetes is met with resistance because of associated weight gain, hypoglycemia, and fear of decreased compliance and quality of life (QoL). RESEARCH DESIGN AND METHODS - In treatment-naive patients with newly diagnosed type 2 diabetes, insulin and metformin were initiated for a 3-month lead-in period, then patients were randomly assigned to insulin and metformin (insulin group) or metformin, pioglitazone, and glyburide (oral group) for 36 months. Hypoglycemic events, compliance, A1C, weight, QoL, and treatment satisfaction were assessed. RESULTS - Of 29 patients randomly assigned into each group, 83{\%} (insulin group) and 72{\%} (oral group) completed this 3-year study. At study completion, A1C was 6.1 ± 0.6{\%} (insulin group) versus 6.0 ± 0.8{\%} (oral group). Weight increased similarly in both groups (P = 0.09) by 4.47 kg (95{\%} CI 0.89-8.04 kg) (insulin group) and 7.15 kg (95{\%} CI 4.18-10.13 kg) (orals group). Hypoglycemic events did not differ between groups (mild 0.51 event/person-month in the insulin group vs. 0.68 event/person-month in the orals group, P = 0.18 and severe 0.04 event/person-year in the insulin group vs. 0.09 event/person-year in the orals group, P = 0.53). Compliance, QoL, and treatment satisfaction were similar between groups, with 100{\%} of patients randomly assigned to insulin willing to continue such treatment. CONCLUSIONS - When compared with a clinically equivalent treatment regimen, insulin-based therapy is effective and did not cause greater weight gain or hypoglycemia nor decrease compliance, treatment satisfaction, or QoL. Insulin is safe, well-accepted, and effective for ongoing treatment of patients with newly diagnosed type 2 diabetes.",
author = "Ildiko Lingvay and Legendre, {Jaime L.} and Kaloyanova, {Polina F.} and Song Zhang and Huet, {Beverley A} and Philip Raskin",
year = "2009",
month = "10",
doi = "10.2337/dc09-0653",
language = "English (US)",
volume = "32",
pages = "1789--1795",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "10",

}

TY - JOUR

T1 - Insulin-based versus triple oral therapy for newly diagnosed type 2 diabetes

T2 - Which is better?

AU - Lingvay, Ildiko

AU - Legendre, Jaime L.

AU - Kaloyanova, Polina F.

AU - Zhang, Song

AU - Huet, Beverley A

AU - Raskin, Philip

PY - 2009/10

Y1 - 2009/10

N2 - OBJECTIVE - Early use of insulin after diagnosis of type 2 diabetes is met with resistance because of associated weight gain, hypoglycemia, and fear of decreased compliance and quality of life (QoL). RESEARCH DESIGN AND METHODS - In treatment-naive patients with newly diagnosed type 2 diabetes, insulin and metformin were initiated for a 3-month lead-in period, then patients were randomly assigned to insulin and metformin (insulin group) or metformin, pioglitazone, and glyburide (oral group) for 36 months. Hypoglycemic events, compliance, A1C, weight, QoL, and treatment satisfaction were assessed. RESULTS - Of 29 patients randomly assigned into each group, 83% (insulin group) and 72% (oral group) completed this 3-year study. At study completion, A1C was 6.1 ± 0.6% (insulin group) versus 6.0 ± 0.8% (oral group). Weight increased similarly in both groups (P = 0.09) by 4.47 kg (95% CI 0.89-8.04 kg) (insulin group) and 7.15 kg (95% CI 4.18-10.13 kg) (orals group). Hypoglycemic events did not differ between groups (mild 0.51 event/person-month in the insulin group vs. 0.68 event/person-month in the orals group, P = 0.18 and severe 0.04 event/person-year in the insulin group vs. 0.09 event/person-year in the orals group, P = 0.53). Compliance, QoL, and treatment satisfaction were similar between groups, with 100% of patients randomly assigned to insulin willing to continue such treatment. CONCLUSIONS - When compared with a clinically equivalent treatment regimen, insulin-based therapy is effective and did not cause greater weight gain or hypoglycemia nor decrease compliance, treatment satisfaction, or QoL. Insulin is safe, well-accepted, and effective for ongoing treatment of patients with newly diagnosed type 2 diabetes.

AB - OBJECTIVE - Early use of insulin after diagnosis of type 2 diabetes is met with resistance because of associated weight gain, hypoglycemia, and fear of decreased compliance and quality of life (QoL). RESEARCH DESIGN AND METHODS - In treatment-naive patients with newly diagnosed type 2 diabetes, insulin and metformin were initiated for a 3-month lead-in period, then patients were randomly assigned to insulin and metformin (insulin group) or metformin, pioglitazone, and glyburide (oral group) for 36 months. Hypoglycemic events, compliance, A1C, weight, QoL, and treatment satisfaction were assessed. RESULTS - Of 29 patients randomly assigned into each group, 83% (insulin group) and 72% (oral group) completed this 3-year study. At study completion, A1C was 6.1 ± 0.6% (insulin group) versus 6.0 ± 0.8% (oral group). Weight increased similarly in both groups (P = 0.09) by 4.47 kg (95% CI 0.89-8.04 kg) (insulin group) and 7.15 kg (95% CI 4.18-10.13 kg) (orals group). Hypoglycemic events did not differ between groups (mild 0.51 event/person-month in the insulin group vs. 0.68 event/person-month in the orals group, P = 0.18 and severe 0.04 event/person-year in the insulin group vs. 0.09 event/person-year in the orals group, P = 0.53). Compliance, QoL, and treatment satisfaction were similar between groups, with 100% of patients randomly assigned to insulin willing to continue such treatment. CONCLUSIONS - When compared with a clinically equivalent treatment regimen, insulin-based therapy is effective and did not cause greater weight gain or hypoglycemia nor decrease compliance, treatment satisfaction, or QoL. Insulin is safe, well-accepted, and effective for ongoing treatment of patients with newly diagnosed type 2 diabetes.

UR - http://www.scopus.com/inward/record.url?scp=70349675747&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70349675747&partnerID=8YFLogxK

U2 - 10.2337/dc09-0653

DO - 10.2337/dc09-0653

M3 - Article

VL - 32

SP - 1789

EP - 1795

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 10

ER -