Impact of concomitant oral glucose-lowering medications on the success of basal insulin titration in insulin-naïve patients with type 2 diabetes: a systematic analysis
Authors' conclusion
OGLM are a major determinant of the success of basal insulin therapy. Sulfonylureas impair, while DPP-4 inhibitors (added to metformin) may facilitate the achievement of ambitious fasting glucose targets.
Study context
- Population
- Insulin-naïve patients with T2D starting basal insulin on a defined oral glucose-lowering medications (OGLM) background in clinical trials42 publications
- Participants
- 17,433 patients
- Comparison
- Basal insulin titration by background OGLM category
- Outcome
- Difference in FPG after titration between OGLM categories
- Follow-up
- After titration
Methodological details60 study arms grouped by OGLM allowed during titration; weighted means and SD; ANOVA with post hoc comparisons
- 60 study arms grouped by OGLM allowed during titration; weighted means and SD; ANOVA with post hoc comparisons
Main finding
As reported in the abstract
FPG after titration
- SU, alone or with metformin, impair basal insulin titration, leading to poorer final glycaemic control
- SU only: P < 0.05 for fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) after titration
- Metformin + DPP-4i vs Metformin only: P < 0.05 for FPG and HbA1c achieved
Further findings
HbA1c after titration
- Poorer with SU (alone or with metformin); better with metformin + DPP-4i vs metformin alone (p<0.05)
Insulin doses
- Insulin doses lower with SU, alone or with metformin
- 30%-40%
Safety
- More hypoglycaemic episodes with SU, alone or with metformin
Original publication
Impact of concomitant oral glucose-lowering medications on the success of basal insulin titration in insulin-naïve patients with type 2 diabetes: a systematic analysis. BMJ Open Diabetes Res Care. Published 11 July 2023. doi:10.
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