Insulin alone may be better for type 2 diabetes than metformin with insulin

Insulin alone may be a better treatment option for type 2 diabetes than metformin and insulin together, according to a study published in the journal BMJ.

The current international consensus is for clinicians to recommend the use of metformin with insulin in almost all patients with type 2 diabetes who initiate insulin treatment.

Researchers from Copenhagen, Denmark studied more than 2,100 adult patients with type 2 diabetes with an intervention period of at least 12 weeks. They also analyzed past clinical trials.

“We were unable to find any evidence or even a trend towards improved all cause mortality or cardivascular mortality with metformin and insulin, compared with insulin alone,” wrote the researchers in their paper.

The researchers did find that metformin combined with insulin seemed to be associated with favorable and significant reduction in HbA1c, weight gain, and insulin dose, compared with insulin alone.

However, severe hypoglycemia was significantly more frequent with metformin and insulin than with insulin alone.

The researchers noted surprisingly incomplete evidence and data on patient relevant outcomes, despite the overwhelmingly accepted practice of prescribing metformin along with insulin to treat type 2 diabetes.

Previous studies have only included a few trials comparing metformin and insulin with insulin alone.

The authors conclude that more studies need to be conducted to provide ample evidence for an effect or absence of an effect of metformin and insulin versus insulin alone.

First-line medication
Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes, according to the American Diabetes Association.

To control glucose levels, many people with diabetes require one or more diabetes medications. Metformin is the first-line medication for patients with type 2 diabetes. It is a glucose-lowering medication that enhances insulin action in the liver.

As the disease progresses, patients may need insulin. Conventional medical wisdom encourages clinicians to prescribe metformin along with insulin because scientists believe it helps reduce blood glucose and body weight.

Adults with diabetes are at high risk for cardiovascular disease. At least 65 percent of those with diabetes die from heart disease or stroke.

Sources: BMJ, American Diabetes Association

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