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lüll An analysis of early insulin glargine added to metformin with or without sulfonylurea: impact on glycaemic control and hypoglycaemia Fonseca V; Gill J; Zhou R; Leahy JDiabetes Obes Metab 2011[Sep]; 13 (9): 814-22AIM: To evaluate the benefits of initiating insulin at an earlier versus later treatment stage, and regimens with/without sulfonylurea (SU). METHODS: Pooled analysis of 11 prospective randomized clinical trials, including 2171 adults with uncontrolled type 2 diabetes initiating insulin glargine following a specific titration algorithm. Clinical outcomes were glycated haemoglobin A1c (HbA1c) reduction, per cent achieving HbA1c = 7.0%, weight gain and hypoglycaemic events. Statistical analysis compared outcomes 24 weeks after basal insulin initiation in patients previously uncontrolled on 0/1 oral antidiabetic drug (OAD) versus 2 OADs, and in patients taking metformin (MET) or SU alone or in combination at baseline. A meta-analysis was also conducted. RESULTS: For the pooled analysis, patients on 0/1 OAD and those on MET monotherapy at baseline had the largest 24-week reductions in HbA1c following the addition of insulin glargine ( approximately 0.44 U/kg). Of patients failing MET/SU monotherapy and MET + SU in combination, 68.1, 50.4 and 56.4% achieved HbA1c = 7.0%, respectively (p = 0.0006). Weight gain was lowest when basal insulin was added to MET. Patients on 0/1 OAD at baseline had significantly less symptomatic hypoglycaemia when basal insulin was added than those on 2 OADs (p = 0.0007). Despite higher insulin doses, those taking MET alone had less hypoglycaemia than those taking SU or MET + SU. Results were confirmed in the meta-analysis. CONCLUSION: Adding insulin glargine to MET monotherapy early in treatment may provide efficacy/safety benefits over regimens including SU. This may reflect treatment earlier in the disease and supports the inclusion of insulin as a second step in the American Diabetes Association/European Association for the Study of Diabetes treatment algorithm.|Algorithms[MESH]|Blood Glucose/*drug effects/physiology[MESH]|Diabetes Mellitus, Type 2/*drug therapy/physiopathology[MESH]|Drug Administration Schedule[MESH]|Drug Therapy, Combination[MESH]|Female[MESH]|Glycated Hemoglobin/*drug effects/physiology[MESH]|Humans[MESH]|Hypoglycemia/*drug therapy/physiopathology[MESH]|Hypoglycemic Agents/*administration & dosage/pharmacology[MESH]|Insulin Glargine[MESH]|Insulin, Long-Acting[MESH]|Insulin/administration & dosage/*analogs & derivatives/pharmacology[MESH]|Male[MESH]|Metformin/*administration & dosage/pharmacology[MESH]|Middle Aged[MESH]|Prospective Studies[MESH]|Randomized Controlled Trials as Topic[MESH]|Sulfonylurea Compounds/*administration & dosage/pharmacology[MESH]|Treatment Outcome[MESH] |