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Treatment intensification in type 2 diabetes management after the failure of two oral hypoglycemic agents: A

Sirajudeen Shaik Alavudeen1, Sultan M Alshahrani1, Easwaran Vigneshwaran1

  • 1Department of Clinical Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia.

International Journal of Clinical Practice
|October 28, 2020
PubMed
Abstract

Insights

Adding insulin to oral hypoglycemic agents (OHAs) effectively manages type 2 diabetes mellitus (T2DM) when two OHAs fail. Insulin add-on therapy improved glycemic control and achieved target HbA1c levels in T2DM patients.

Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Pharmacology

Background:

  • Type 2 diabetes mellitus (T2DM) management often requires intensified therapy after initial treatments fail.
  • Oral hypoglycemic agents (OHAs) are common first- and second-line treatments, but many patients eventually require additional interventions.
  • Assessing treatment strategies post-OHA failure is crucial for optimizing glycemic control and preventing complications.

Purpose of the Study:

  • To evaluate the safety and efficacy of different treatment approaches for T2DM patients who have not achieved glycemic control with two OHAs.
  • To compare outcomes of adding a third OHA, biphasic insulin, basal insulin, or insulin monotherapy.

Main Methods:

  • An ambispective study was conducted at Asir Diabetes Center, KSA, from June 2013 to June 2014.
  • Included were T2DM patients with HbA1c >7.0% on two OHAs for at least 6 months.
  • Patients were assigned to four groups: three OHAs, biphasic insulin + metformin, two OHAs + basal insulin, or insulin monotherapy.

Main Results:

  • A total of 255 patients were enrolled across four treatment groups.
  • Significant reductions in HbA1c were observed when insulin was added to OHAs.
  • Groups receiving insulin add-on therapy (biphasic or basal) showed higher rates of achieving target HbA1c (<7.0%), while insulin monotherapy had more hypoglycemic events.

Conclusions:

  • Insulin as an add-on therapy to oral hypoglycemic agents is a viable strategy for T2DM patients with insufficient glycemic control on dual OHA therapy.
  • Combining insulin with existing OHAs demonstrates efficacy in improving HbA1c levels.
  • Careful consideration of treatment type is needed to balance glycemic control and hypoglycemia risk.

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