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Insulin Monotherapy Versus Insulin Combined with Other Glucose-Lowering Agents in
Type 2 Diabetes: A Narrative Review
#MMPMID30008760
Abdi H
; Azizi F
; Amouzegar A
Int J Endocrinol Metab
2018[Apr]; 16
(2
): e65600
PMID30008760
show ga
CONTEXT: Insulin can be prescribed as a monotherapy or a combined therapy with
other anti-diabetic medications. In this narrative review, the authors aimed to
gather data related to comparison of insulin monotherapy versus combination of
insulin and other anti-diabetic treatments with regards to different outcome
measures in type 2 diabetes. EVIDENCE ACQUISITION: This study searched and
focused on the most recently published systematic reviews and their references
investigating issues related to the primary aim. RESULTS: The current data
available on this topic is heterogeneous and suffers from low quality with
respect to most combination treatments. Considering the efficacy and safety of
combination therapy of insulin with older hypoglycemic agents, in general
metformin and pioglitazone have the best and worst profiles, respectively.
Compared to insulin monotherapy, combination of insulin and metformin is
associated with better glycemic control, reduced daily insulin dose, less
hypoglycemia, and weight gain; combination of insulin and pioglitazone results in
greater hypoglycemia and weight gain and is associated with increased risk of
edema and heart failure. Regarding sulphonylurea, there is some concern regarding
hypoglycemia and weight gain. Addition of dipeptidyl peptidase-4 inhibitors to
insulin seems to be beneficial with respect to glycemic control without any
significant adverse effects. New drugs, including glucagon-like peptide-1
agonists and sodium glucose co-transporter 2 inhibitors, have acceptable profiles
with significant benefits regarding weight reduction when added on insulin
therapy. CONCLUSIONS: Considering the quality and longevity of evidence, compared
to insulin monotherapy, insulin combined with metformin and pioglitazone has the
best and worst profiles, respectively. New anti-diabetic medications have
acceptable profiles yet are expensive. It is important for clinicians to
meticulously weigh the advantages of combination therapy against the possible
adverse effects with each drug class in every patient, individually.
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