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Item #4
Combination
of Insulin and Metformin in the Treatment of Type 2 Diabetes
The
combination of insulin and metformin results in superior
glycemic control.
The
study investigated the metabolic effects of metformin, as
compared with placebo, in type 2 diabetic patients intensively treated
with insulin.
Metformin
improves glycemic control in poorly controlled type 2
diabetic patients. Its effect in type 2 diabetic patients
who are intensively treated with insulin has not been
studied. A total of 390 patients whose type 2 diabetes was
controlled with insulin therapy completed a randomized
controlled double-blind trial with a planned interim analysis
after 16 weeks of treatment. The subjects were selected from
three outpatient clinics in regional hospitals and were randomly
assigned to either the placebo or metformin group, in
addition to insulin therapy. Intensive glucose monitoring with
immediate insulin adjustments according to strict guidelines was
conducted. Indexes of glycemic control, insulin requirements, body
weight, blood pressure, plasma lipids, hypoglycemic events, and
other adverse events were measured.
The
Results from the 390 subjects showed, 37 dropped out (12 in the
placebo and 25 in the metformin group). Of those who completed
16 weeks of treatment, metformin use, as compared with placebo,
was associated with improved glycemic control (mean daily
glucose at 16 weeks 7.8 vs. 8.8 mmol/l, P = 0.006;
mean GHb 6.9 vs. 7.6%, P < 0.0001); reduced
insulin requirements (63.8 vs. 71.3 IU, P <
0.0001); reduced weight gain (-0.4 vs. +1.2 kg, P
< 0.01); and decreased plasma LDL cholesterol (-0.21 vs.
-0.02 mmol/l, P < 0.01). Risk of hypoglycemia was similar
in both groups.
From
the results it was concluded that, in type 2 diabetic patients
who are intensively treated with insulin, the combination
of insulin and metformin results in superior glycemic
control compared with insulin therapy alone, while insulin
requirements and weight gain are less.
Diabetes
Care 25:2133-2140, 2002
DID
YOU KNOW:
In
1994, more than half of all persons with diabetes (4.1 million at that
time) reported that they were limited in activity, and more than 60%
attributed their limitation to diabetes (Centers for Disease
Control and Prevention, 1997).
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