Related Experiment Video

Updated: Jul 10, 2026

Glucose Uptake Measurement and Response to Insulin Stimulation in In Vitro Cultured Human Primary Myotubes
08:03

Glucose Uptake Measurement and Response to Insulin Stimulation in In Vitro Cultured Human Primary Myotubes

Published on: June 25, 2017

Glycemic response to newly initiated diabetes therapies

Andrew J Karter1, Howard H Moffet, Jennifer Liu

  • 1Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA. andy.j.karter@kp.org

The American Journal of Managed Care
|November 9, 2007
PubMed
Abstract

Insights

Most type 2 diabetes medications like metformin and insulin showed similar effectiveness in lowering A1C. However, many patients still didn't reach their glycemic target, indicating a need for earlier, more aggressive treatment intensification.

Area of Science:

  • Endocrinology
  • Pharmacology
  • Public Health

Background:

  • Real-world glycemic response to antihyperglycemic therapies for type 2 diabetes is understudied.
  • Randomized controlled trials provide limited insight into actual clinical practice.

Purpose of the Study:

  • To evaluate the real-world effectiveness of initiating new antihyperglycemic agents in type 2 diabetes patients.
  • To compare the glycemic response across different classes of antihyperglycemic medications.

Main Methods:

  • A cohort of 15,126 type 2 diabetes patients initiating metformin, sulfonylureas, thiazolidinediones, or insulin was studied.
  • Glycosylated hemoglobin (A1C) changes were analyzed 3-12 months post-initiation using ANCOVA.
  • Analyses were adjusted for baseline A1C, concurrent therapies, demographics, and clinical factors.

Main Results:

  • Mean A1C decreased from 9.01% to 7.87% after initiating new therapy.
  • Only 30.2% of patients achieved a glycemic target of A1C < 7%.
  • No significant differences in glucose-lowering effects were observed among metformin, sulfonylureas, thiazolidinediones, and insulin after adjustments.

Conclusions:

  • Metformin, sulfonylureas, thiazolidinediones, and insulin demonstrate comparable efficacy in improving glycemic control.
  • A majority of patients do not achieve target A1C levels, highlighting a gap in treatment.
  • Earlier and more aggressive therapy intensification is recommended to manage progressive glycemic worsening.

More Related Videos

Glycemic Impact on Knee Osteoarthritis Symptoms on Physical, Radiographic, and Inflammatory Markers among Individuals Aged 50 and Over with Diabetes07:22

Glycemic Impact on Knee Osteoarthritis Symptoms on Physical, Radiographic, and Inflammatory Markers among Individuals Aged 50 and Over with Diabetes

Published on: March 7, 2025

Related Concept Videos

Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

Oral Hypoglycemic Agents: Biguanides and Glitazones

Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood glucose levels...
Oral Hypoglycemic Agents: Glinides01:06

Oral Hypoglycemic Agents: Glinides

Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively manages...
Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: Dosing Regimen and Adverse Effects

Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
Diabetes: Management and Pharmacotherapy01:15

Diabetes: Management and Pharmacotherapy

The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Hypoglycemia and Glucagon01:15

Hypoglycemia and Glucagon

Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
Diabetes Mellitus: Type 2 and Gestational01:22

Diabetes Mellitus: Type 2 and Gestational

Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...