INITIATE STUDY: Insulin versus Oral Hypoglycemic Agent as Initial Therapy for Newly Diagnosed Diabetes Mellitus Type 2: A Systematic Review and Meta-Analysis

Authors

  • Ma. Marylaine Dujunco Department of Medicine St. Luke's Medical Center Quezon City, Philippines http://orcid.org/0000-0002-7236-1978
  • June Hayrelle Gorriceta Department of Medicine St. Luke's Medical Center Quezon City, Philippines
  • Oliver Allan Dampil Section of Endocrinology and Metabolism St. Luke's Medical Center Quezon City, Philippines
  • Roberto Mirasol Section of Endocrinology and Metabolism St. Luke's Medical Center Quezon City, Philippines

Abstract

Objectives. This study aims to evaluate the effectiveness of initial insulin therapy versus oral hypoglycemic agents in glucose control among newly diagnosed Type 2 diabetes patients.

Methodology. This is a systematic review and meta-analysis of RCTs with quality grade B searched using the medical subject headings (MeSH):  diabetes mellitus type 2, insulin, oral hypoglycemic agent, with adults newly diagnosed with type 2 DM as subjects and given insulin (± metformin) vs. OHA. Results were summarized as graphs and forest plots using the random effects due to foreseen sources of heterogeneity using Review Manager version 5.1. 

Results. Presence of substantial heterogeneity prevents us from making a conclusion. All four studies showed lower post treatment BMI among participants in the insulin treatment arm. An opposite finding was expected as insulin is known to cause weight gain.  Main adverse effect was hypoglycemia.

Conclusion.  Among newly diagnosed type 2 DM patients, there is insufficient evidence for or against the use of insulin compared to oral hypoglycemic agents as initial management in terms of improvement in glycemic control, decrease in insulin resistance, and improvement in beta cell function.

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Author Biographies

Ma. Marylaine Dujunco, Department of Medicine St. Luke's Medical Center Quezon City, Philippines

Department of Medicine

June Hayrelle Gorriceta, Department of Medicine St. Luke's Medical Center Quezon City, Philippines

Department of Medicine

Chief Resident

Oliver Allan Dampil, Section of Endocrinology and Metabolism St. Luke's Medical Center Quezon City, Philippines

Section of Endocrinology and Metabolism

Roberto Mirasol, Section of Endocrinology and Metabolism St. Luke's Medical Center Quezon City, Philippines

Section of Endocrinology and Metabolism

Chairman

References

IDF Diabetes Atlas Sixth Edition, International Diabetes Federation 2013.

Garber AJ, et al. AACE Comprehensive Diabetes Management Algorithm. Endocr Pract. 2013;19:327-336.

Chang-Chen, KJ, Mullur R, Bernal-Mizrachi E. Beta-cell failure as a complication of diabetes. Rev Endocr Metab Disord. 2008 Dec; 9(4):329-43.

http://dx.doi.org/10.1007/s11154-008-9101-5.

Age-Adjusted Percentage of Adults with Diabetes Using Diabetes Medication, by Type of Medication, United States, 1997–2011. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey. Nov 2013.

Shin MS, et al. The Duration of Sulfonylurea Treatment Is Associated with β-Cell Dysfunction. Diabetes Technol Ther. 2012 Nov;14(11):1033-42. http://dx.doi.org/10.1089/dia.2012.0144.

Nathan DM: Initial management of glycemia in type 2 diabetes mellitus. N Engl J Med. 347:1342 -1349, 2002. http://dx.doi.org/ 10.1056/NEJMcp021106.

Ildiko L, et al. Insulin-Based Versus Triple Oral Therapy for Newly Diagnosed Type 2 Diabetes: Which is better? Diabetes Care. October 2009; 32 (10):1789-1795. http://dx.doi.org/10.2337/dc09-0653.

Niswender K, et al. Early and Aggressive Initiation of Insulin Therapy for Type 2 Diabetes: What Is the Evidence? Clinical Diabetes. Spring 2009;27(2): 60-68. http://dx.doi.org/10.2337/diaclin.27.2.60.

Turner, et al. (1993) Measurement of insulin resistance and β-cell function: the HOMA and CIGMA approach. Current topics in diabetes research (eds) F. Belfiore, R. Bergman and G. Molinatti Front Diabetes. Basel, Karger. 12: 66-75.

Executive Summary: Standards of medical care in diabetes-2010. Diabetes Care. Jan 2010; 33 (Suppl 1): s4-s10. http://dx.doi.org/10.2337/dc10-S004.

Prentki M, Nolan CJ. Islet beta cell failure in type 2 diabetes. J Clin Invest. 2006;116:1802–1812. http://dx.doi.org/10.1172/JCI29103.

Ryden L, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. Aug. 2013;34(39):3035-3087. http://dx.doi.org/10.1093/eurheartj/eht108.

Harrison LB, et al. Beta-cell function preservation after 3.5 years of intensive diabetes therapy. Diabetes Care. July 2012; 35(7):1406-1412. http://dx.doi.org/10.2337/dc11-2170.

Hu Y, Li L, Xu Y, et al. Short-term intensive therapy in newly diagnosed type 2 diabetes partially restores both insulin sensitivity and β-cell function in subjects with long-term remission. Diabetes Care. Aug 2011; 34(8):1848-53. http:/dx/doi.org/10.2337/dc10-2105.

Joya-Galeana J, et al. Effects of insulin and oral anti-diabetic agents on glucose metabolism, vascular dysfunction and skeletal muscle inflammation in type 2 diabetic subjects. Diabetes/Metabolism Research and Reviews. 2011; 27(4); 373-382. http://dx.doi.org/ 10.1002/dmrr.1185.

Turner RC, et al. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: Progressive requirement for multiple therapies (UKPDS 49). JAMA. June 2, 1999; 281(21): 2005-2012. http://dx.doi.org/ 10.1001/jama.281.21.2005.

Chen HS, et al. Beneficial effects of insulin on glycemic control and beta cell function in newly diagnosed type 2 diabetes with severe hyperglycemia after short term intensive insulin therapy. Diabetes Care. Oct. 2008; 31(10):1927-1932. http://dx.doi.org/10.2337/dc08-0075.

Weng J, et al. Effect of intensive insulin therapy on beta cell function and glycemic control in patients with newly diagnosed type 2 diabetes: A multicenter randomized parallel-group trial. Lancet. May 24, 2008; 371:1753-1760. http://dx.doi.org/10.1016/S0140-6736(08)60762-X.

Published

2014-11-29

How to Cite

Dujunco, M. M., Gorriceta, J. H., Dampil, O. A., & Mirasol, R. (2014). INITIATE STUDY: Insulin versus Oral Hypoglycemic Agent as Initial Therapy for Newly Diagnosed Diabetes Mellitus Type 2: A Systematic Review and Meta-Analysis. Journal of the ASEAN Federation of Endocrine Societies, 29(2), 172. Retrieved from https://asean-endocrinejournal.org/index.php/JAFES/article/view/149

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