Background: Insulin therapy should be strongly considered in newly diagnosed type 2 diabetic (T2D) patients with severe hyperglycemia. However, whether insulin be continued or patients switched to an oral antidiabetic drug (OAD) after short-term intensive insulin therapy (ITT) is not clear.
Methods: After ITT for 10-14 days, 47 patients were randomized into either a glargine (n = 21) or metformin-based OAD (n = 26) group for a 6-month intervention. After these 6 months, patients in the glargine group were switched to metformin-based OAD therapy, whereas treatment in the OAD group was unchanged. Patients were followed-up for another 6 months.
Results: At the end of the 6-month intervention, HbA1c was similarly reduced in both the glargine (from 11.81 ± 1.70% to 6.48 ± 0.79%; P < 0.001) and OAD (from 11.71 ± 1.89% to 6.16 ± 0.52%; P < 0.001) groups. At the end of 12 months, HbA1c was at comparable and near optimal levels in both groups. Similar increases were seen in homeostatic model assessment of β-cell function in the two groups after 6 months. There were no significant differences between the two groups in insulin sensitivity improvement, hypoglycemic episodes, weight change, treatment satisfaction and quality of life after the 6-month intervention.
Conclusions: The effects of metformin-based OAD therapy on glycemic control and improvements in β-cell function are not inferior to glargine in newly diagnosed T2D patients with severe hyperglycemia after short-term ITT. Considering the superiority of metformin in terms of safety, cost, and convenience, metformin-based OAD therapy is strongly recommended for these patients.
Keywords: glargine; intensive insulin therapy; metformin; type 2 diabetes mellitus; 关键词：甘精胰岛素，胰岛素强化治疗，二甲双胍，2型糖尿病.
© 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.