Metformin After Insulin Therapy Induction Beneficial in Long-Term

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In total, 66.7% participants assigned to metformin had HbA<sub>1c</sub> levels ≤6% at study completion.
In total, 66.7% participants assigned to metformin had HbA1c levels ≤6% at study completion.

HealthDay News — After induction short-term intensive insulin therapy (IIT), metformin is superior to intermittent IIT for maintaining beta-cell function and glycemic control over 2 years, according to a study published online in Diabetes, Obesity and Metabolism.

Ravi Retnakaran, MD, from the University of Toronto, and colleagues randomized 24 adults with type 2 diabetes (T2D) of 2 years' duration and A1c of 6.4 to 3 weeks of induction IIT (glargine, lispro) followed by either repeat IIT for up to 2 weeks every 3 months or daily metformin.

The researchers found that baseline-adjusted Insulin Secretion-Sensitivity Index-2 at 2 years was higher in the metformin arm compared to intermittent IIT (245 ± 31.7 vs 142.2 ± 18.4).

Baseline-adjusted A1c at 2 years was lower in the metformin arm (6% ± 0.2% vs 7.3% ± 0.2%). Two-thirds of participants (66.7%) randomly assigned to metformin had A1c ≤6% at study completion vs 8.3% of those on intermittent IIT. No differences in insulin sensitivity were seen.

"The strategy of induction and maintenance therapy to preserve beta-cell function warrants exploration in early T2DM," the authors write.

One author disclosed financial ties to the pharmaceutical industry.

Reference

Retnakaran R, Choi H, Ye C, Kramer CK, Zinman B. Two-year trial of intermittent insulin therapy vs metformin for the preservation of beta-cell function after initial short-term intensive insulin induction in early type 2 diabetes [published online January 23, 2018]. Diabetes Obes Metab. doi: 10.1111/dom.13236

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