Combining insulins with oral antidiabetic agents: effect on hyperglycemic control, markers of cardiovascular risk and disease

Abstract

Abstract:Patients with type 2 diabetes mellitus (T2DM) have an increased risk of cardiovascular disease (CVD). Unfortunately, several potential barriers exist for CVD risk management in diabetes, including the need for signifi cant lifestyle changes, potential problems with hypoglycemia, weight gain, injection tolerability, treatment complexity with current diabetes therapies and other, unmodifi able factors. Improving glycemic control may impact CVD risk. Treatment of T2DM usually starts with lifestyle changes such as diet and exercise. When these become insuffi cient, pharmacotherapy is required. Various oral antidiabetic drugs (OADs) are available that reduce hyperglycemia. The fi rst line of therapy is usually metformin, since it does not increase weight and seems to have a benefi cial effect on CVD mortality and risk factors. As T2DM progresses, insulin treatment becomes necessary for the majority of patients. The last few years have seen the development of long-acting, rapid-acting, and premixed insulin analog formulations. The treat-to-target algorithms of recent studies combining OADs plus insulin analogs have demonstrated that patients can reach glycemic treatment targets with low risk of hypoglycemia, greater convenience, and -with some analogs -limited weight gain vs conventional insulins. These factors may possibly have a positive infl uence on CVD risk. Future studies will hopefully elucidate the benefi ts of this approach.

Assessment of Prescription Pattern of Antidiabetic Drugs in the Outpatient Department of a Tertiary Care Hospital

“…Poor Glycemic control in diabetes mellitus can sometimes be prevented by rational use of oral Hypoglycemic Agents (OHAs) and insulin [3]. Rational use of the drugs is a defi ned as follows:…”

Clinical outcomes after insulin initiation in patients with type 2 diabetes: 6-month data from the INSTIGATE observational study in five European countries

“…Insulin is generally given as second line therapy when lifestyle changes and initial oral therapies have failed [3][4][5] . Treatment algorithms suggest starting with once-daily formulations, but other insulin regimens have been suggested and there is little consensus regarding the best options for intensification [3][4][5][6] . However, even with insulin use, less than half of all patients achieve glycaemic control targets of HbA1c 57% 7,8 .…”

Classification, Pathophysiology, Diagnosis and Management of Diabetes Mellitus

“…In patients with severe coexisting conditions that could interfere with implementation of the management strategy, the goal is prevention of clinically significant glycosuria, water and electrolyte loss, infections, and the development of non ketotic hyperosmolar coma. Insulin is indicated for type 1 diabetes as well as for type 2 diabetic patients with insulinopenia whose hyperglycemia does not respond to diet therapy either alone or combined with oral hypoglycemic drugs [60]. Controlling blood glucose with insulin has the potential to be the most effective blood glucose-lowering therapy [61].…”