Insulin monotherapy ‘suboptimal’ for kind 2 diabetes

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medwireNews: Real study results suggest that people with type 2 diabetes who are treated with insulin monotherapy achieve poorer clinical results than people who receive combination treatment with insulin and other antidiabetic drugs.

Nils Picker (Ingress-Health HWM GmbH, Wismar, Germany) and his team used German medical claims data to assess treatment-related outcomes in 12,034 people with type 2 diabetes who started insulin treatment between 2013 and 2015. A total of 29% received insulin monotherapy, while the remaining 71% received antidiabetic drugs at the same time.

As reported in diabetes research and in clinical practice, the proportion of people with glycated hemoglobin (HbA1c) in the target range of 6.5–7.5% (48–58 mmol / mol) improved from baseline to 1 year -Follow-up, regardless of whether insulin was taken alone or with other medications. However, Picker and the team found that this improvement was “significantly less” in people who received insulin monotherapy compared to other therapies.

In particular, the proportion of people with HbA1c levels in the target range improved from 24.5% to 35.2% among the 3426 people who received insulin monotherapy, which corresponds to an increase of 10.7 percentage points (pp). This increased to an increase of 13.1 pp in the 2,863 people who were administered insulin plus a non-metformin anti-diabetic drug (from 22.5% to 35.6%) and to an increase of 18.4 pp in the 3782 people who took insulin plus metformin and another antidiabetic drug (from 18.8% to 37.2%)%). The improvement was greatest at 21.1 pp (from 16.3% to 37.4%) in the 1963 people who received insulin plus metformin.

In a multivariate analysis, people taking insulin plus metformin and insulin plus metformin and another anti-diabetic drug were significantly more likely to reach target HbA1c levels at 1-year follow-up than people taking insulin monotherapy Odds ratios (ORs) were administered. of 1.18 and 1.15, respectively.

The researchers also found that all three combination regimens were associated with a significantly reduced risk of weight gain (≥ 10% of body weight from baseline up to 1 year) compared to insulin monotherapy, with ORs for insulin plus metformin and another antidiabetic between 0 .50 ranged from 0.71 for insulin plus a non-metformin agent.

In addition to the limited benefits associated with insulin monotherapy, Picker and colleagues also note that the costs were “by far the highest” with this regimen. The total cost per person per year was € 12,283 (US $ 14,615) compared to € 9,947-10,509 (US $ 11,835-12,504).

Taken together, these results suggest that “insulin alone is a sub-optimal treatment” for type 2 diabetes, the study’s authors conclude.

medwireNews is an independent medical news service from Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

Diabetes Res Clin Pract 2021; doi: 10.1016 / j.diabres.2021.108734