Triple Therapy in Type 2 Diabetes

Rosenstock, Julio; Sugimoto, Danny; Strange, Poul; Stewart, John A.; Soltes-Rak, Erika; Dailey, George

doi:10.2337/diacare.29.03.06.dc05-0695

Cited by 203 publications

(145 citation statements)

References 21 publications

(24 reference statements)

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“…The clinical trials showed that the use of basal insulin as an add‐on to OAD in patients with type 2 diabetes achieved 7% HbA1c, and approximately half of the patients experienced symptomatic hypoglycemia20, 21, 22, 23, 24. However, in real‐world practice, a retrospective USA study and two prospective studies in Ireland and Japan found that approximately just 20% of the patients taking basal insulin could achieve HbA1c <7% with a low rate of hypoglycemia16, 25, 26.…”

Section: Introductionmentioning

confidence: 99%

Glycemic control and adherence to basal insulin therapy in Taiwanese patients with type 2 diabetes mellitus

Chien

Chen²,

Hung

et al. 2016

J of Diabetes Invest

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Aims/IntroductionThe aim of the present study was to assess the glycemic control, adherence and treatment satisfaction in a real‐world setting with basal insulin therapy in type 2 diabetes patients in Taiwan.Materials and MethodsThis was a multicenter, prospective, observational registry. A total of 836 patients with type 2 diabetes taking oral antidiabetic drugs with glycated hemoglobin (HbA1c) >7% entered the study. Basal insulin was given for 24 weeks. All treatment choices and medical instructions were at the physician's discretion to reflect real‐life practice.ResultsAfter 24‐week treatment, 11.7% of patients reached set HbA1c goals without severe hypoglycemia (primary effectiveness end‐point). HbA1c and fasting blood glucose were significantly decreased from (mean ± SD) 10.1 ± 1.9% to 8.7 ± 1.7% (−1.4 ± 2.1%, P < 0.0001) and from 230.6 ± 68.8 mg/dL to 159.1 ± 55.6 mg/dL (−67.4 ± 72.3 mg/dL, P < 0.0001), respectively. Patients received insulin therapy at a frequency of nearly one shot per day on average, whereas self‐monitoring of blood glucose was carried out approximately four times a week. Hypoglycemia was reported by 11.4% of patients, and only 0.7% of patients experienced severe hypoglycemia. Slight changes in weight (0.7 ± 2.4 kg) and a low incidence of adverse drug reactions (0.4%) were also noted. The score of 7‐point treatment satisfaction rated by patients was significantly improved by 1.9 ± 1.7 (P < 0.0001).ConclusionsBasal insulin therapy was associated with a decrease in HbA1c and fasting blood glucose, and an improved treatment satisfaction. Most patients complied with physicians' instructions. The treatment was generally well tolerated by patients with type 2 diabetes, but findings pointed out the need to reinforce the early and appropriate uptitration to achieve treatment targets.

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Section: Introductionmentioning

confidence: 99%

Glycemic control and adherence to basal insulin therapy in Taiwanese patients with type 2 diabetes mellitus

Chien

Chen²,

Hung

et al. 2016

J of Diabetes Invest

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“…Indeed, since diabetes is associated with progressive b-cell loss, many patients, especially those with long-standing disease, will eventually need to be transitioned to insulin, which should be favored in circumstances where the degree of hyperglycemia (e.g., ≥ 8.5%) makes it unlikely that another drug will be of sufficient benefit. 87 If triple combination therapy exclusive of insulin is tried, the patient should be monitored closely, with the approach promptly reconsidered if it proves to be unsuccessful. Many months of uncontrolled hyperglycemia should specifically be avoided.…”

Section: Position Statementmentioning

confidence: 99%

Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

et al. 2012

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“…Similarly, though DIGAMI-2 trial[20] had three arms, it was chosen the insulin and non-insulin arms were clearly defined and outcomes compared between these two. Finally, 18 clinical trials [15,16,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] were selected for meta-analysis (Figure 1). …”

Section: Literature Search Resultsmentioning

confidence: 99%

Comparison of cardiovascular and metabolic outcomes in people with type 2 diabetes on insulin versus non-insulin glucose-lowering therapies (GLTs): A systematic review and meta-analysis of clinical trials

Anyanwagu

Mamza

Donnelly

et al. 2016

Diabetes Research and Clinical Practice

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Objectives: To compare the cardiovascular and metabolic outcomes of Insulin versus noninsulin glucose lowering therapy (GLT).Methods: We included randomised control trials (RCTs) which randomised patients aged >18 years with Type 2 Diabetes (T2D) to insulin vs non-insulin GLT. We used risk ratios (RR), risk difference (RD) and odds ratios (OR) with 95% confidence interval (95%CI) to analyse the treatment effects of dichotomous outcomes and mean differences (with 95% CI) for continuous outcomes.Results: We included 18 RCTs with 19,300 participants. There was no significant difference in the risk of all-cause mortality and CV events between the groups (RR= 1.01; 95%CI: 0.96 -1.06; p = 0.69). In 16 trials, insulin showed greater efficacy in glycaemic control (mean diff= -0.20; 95%CI: -0.28 to -0.11 but the proportion achieving HbA1c level of either ≤7.0% or 7.4% (53 or 57mmol/mol) was similar in both (OR=1.55; 95%CI= 0.92 to 2.62). The non-insulin group had a significant reduction in weight (mean diff = -3.41; 95%CI: -4.50 to -2.32) and an increase in the proportion of adverse events (54.7% vs 45.3%, p= 0.044), but the insulin group showed an (RR= 1.90; 95%CI: 1.44 to 2.51) increased risk of hypoglycaemia.Conclusion: There was no difference in the risk of all-cause mortality and adverse cardiovascular (CV) events between Insulin and non-insulin GLTs. Insulin was associated with superior reduction in HbA1c; least reduction in weight and higher risk of hypoglycaemia. Both showed similar proportion of patients achieving HbA1c target. Noninsulin GLTs were associated with a higher risk in reported adverse drug events.3 | P a g e Introduction:For many patients with type 2 diabetes (T2D), treatment intensification using additional antihyperglycaemic agents is required in order to achieve optimal glycaemic control and prevent long-term vascular complications.[1, 2] A variety of antihyperglycaemic agents are available but questions regarding the long term safety and efficacy of some of these agents have been raised. In addition, recent focus by international regulatory agencies on the cardiovascular (CV) safety profile of commonly used antihyperglycaemic agents [3,4] have led to debate about the most appropriate choice of therapy for treatment intensification.Amidst this, exogenous insulin remains to be one of the most established glucose lowering therapies available [5][6][7][8][9][10] and its use in people with T2D has grown markedly over recent years. More recently however, the effectiveness and safety of insulin therapy has been a subject of intense discussion.[11-13] Moreover, recent large epidemiological studies have reported adverse cardiovascular CV outcome and increase mortality with insulin compared with non-insulin therapy. [13, 14] While the possible mechanism behind the observed the association between insulin and adverse cardiovascular and metabolic outcomes and mortality remains unclear, it is hypothesized that these may include, but not limited to, hypoglycaemia and weight gain. Although insulin the...

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Triple Therapy in Type 2 Diabetes

Cited by 203 publications

References 21 publications

Glycemic control and adherence to basal insulin therapy in Taiwanese patients with type 2 diabetes mellitus

Glycemic control and adherence to basal insulin therapy in Taiwanese patients with type 2 diabetes mellitus

Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

Comparison of cardiovascular and metabolic outcomes in people with type 2 diabetes on insulin versus non-insulin glucose-lowering therapies (GLTs): A systematic review and meta-analysis of clinical trials

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