Metformin After Insulin Therapy Induction Beneficial in Long-Term
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.
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