Comparison of the glycemic control of insulin and triple oral therapy in type 2 diabetes mellitus

Abstract

To compare the glycemic control of triple oral therapy with sulfonylurea, metformin and acarbose with insulin in type 2 diabetes mellitus patients. This was a prospective observational study, carried out in Sardjito Hospital in Yogyakarta Indonesia, from May 2007 - September 2008. The target population in patients diagnosed with type 2 diabetes who failed with oral antidiabetic medications. At baseline and at 3 -month intervals, level of HbA1C, fasting plasma glucose (FPG), postprandial plasma glucose (PPG), hypoglycemic episodes, and adverse events were evaluated. Test for differences between the two groups were performed by Chi-Square test for categorical variables and by independent-samples t-test for continuous variables. Paired t-test was performed for pre-post measurements. All tests were performed using a two-tailed test at a significance level of 0.05. One hundred and fifteen patients (58 men and 57 women), aged 62.35 ± 8.88, and diabetes duration of 12.53 ± 6.97 years were studied. Over the 6 -month treatment period, HbA1c levels decreased from 8.85 ± 2.02 to 8.33 ± 1.94% with insulin group (P = 0.011) and increased from 8.08 ± 1.89 to 8.73 ± 2.37% with triple oral therapy (P = 0.041). FPG and PPG levels decreased from 169.42 - 138.44 mg/dl (P = 0.002) and 238.26 - 197.97 mg/dl (P = 0.001) with insulin and increased from 160.39 - 170.71 mg/dl (P = 0.183) and 210.31 - 218.67 mg/dl (P = 0.458) with triple oral therapy, respectively. Addition of insulin in poorly controlled type 2 diabetic patients on metformin/sulfonylurea achieved a significantly greater reduction in HbA1c, fasting plasma glucose, and postprandial plasma glucose versus those treated with sulfonylurea, metformin, and acarbose. Key words: Insulin, triple oral therapy, glycemic effect, type 2 diabetes mellitus, Indonesia.