ASSESSING THE IMPACT OF INSULIN GLARGINE AND METFORMIN COMBINATION THERAPY ON GLYCEMIC CONTROL IN TYPE 2 DIABETES MELLITUS

Main Article Content

Sadia Butt
Tahira Akhtar
Iqra Arif
Zara Sagheer
Shahid Masood
Ammar Farooq

Keywords

Type 2 Diabetes Mellitus, insulin glargine, metformin, glycemic control, observational study.

Abstract

Introduction: The purpose of this one-year prospective, single-center, observational cohort


research was to assess how insulin glargine and metformin together affect glycemic control in people with Type 2 Diabetes Mellitus (T2DM).


Methods: The trial, which was conducted at Services Hospital, Lahore involved 205 patients who were starting combination treatment with metformin and insulin glargine. Every three months, the HbA1c, insulin dose, and fasting blood glucose levels were assessed.


Results: Significant decreases were seen with respect to HbA1c (p < 0.001) & fasting blood sugar levels (p < 0.001). Insulin dosage was increased from 30 to 32 units per day. The majority of the rare side effects were moderate hypoglycemia.


Conclusion: The research confirms that insulin glargine and metformin combination treatment is safe and effective in helping people with type 2 diabetes achieve glycemic control. The single-center design and lack of a comparator group are among the limitations. Future studies need to examine long-term results and take a more comprehensive look at patient demographics.

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References

1. Hollander P, Sugimoto D, Vlajnic A, Kilo C. Combination therapy with insulin glargine plus metformin but not insulin glargine plus sulfonylurea provides similar glycemic control to triple oral combination therapy in patients with type 2 diabetes uncontrolled with dual oral agent therapy. Journal of diabetes and its complications. 2015 Nov 1;29(8):1266-71.
2. Gebrie D, Manyazewal T, A Ejigu D, Makonnen E. Metformin-insulin versus metformin-sulfonylurea combination therapies in type 2 diabetes: a comparative study of glycemic control and risk of cardiovascular diseases in Addis Ababa, Ethiopia. Diabetes, Metabolic Syndrome and Obesity. 2021 Jul 24:3345-59.
3. Giorgino F, Caruso I, Napoli R. Titratable fixed-ratio combination of insulin glargine plus lixisenatide: a simplified approach to glycemic control in type 2 diabetes mellitus. Diabetes Research and Clinical Practice. 2020 Dec 1;170:108478.
4. Carlson AL, Mullen DM, Mazze R, Strock E, Richter S, Bergenstal RM. Evaluation of insulin glargine and exenatide alone and in combination: a randomized clinical trial with continuous glucose monitoring and ambulatory glucose profile analysis. Endocrine Practice. 2019 Apr 1;25(4):306-14.
5. Dahl D, Onishi Y, Norwood P, Huh R, Bray R, Patel H, Rodríguez Á. Effect of subcutaneous tirzepatide vs placebo added to titrated insulin glargine on glycemic control in patients with type 2 diabetes: the SURPASS-5 randomized clinical trial. Jama. 2022 Feb 8;327(6):534-45.
6. Lingvay I, Manghi FP, García-Hernández P, Norwood P, Lehmann L, Tarp-Johansen MJ, Buse JB, Dual V Investigators. Effect of insulin glargine up-titration vs insulin degludec/liraglutide on glycated hemoglobin levels in patients with uncontrolled type 2 diabetes: the DUAL V randomized clinical trial. Jama. 2016 Mar 1;315(9):898-907.
7. Hanefeld M, Monnier L, Schnell O, Owens D. Early treatment with basal insulin glargine in people with type 2 diabetes: lessons from ORIGIN and other cardiovascular trials. Diabetes Therapy. 2016 Jun;7:187-201.
8. Yan J, Yao B, Kuang H, Yang X, Huang Q, Hong T, Li Y, Dou J, Yang W, Qin G, Yuan H. Liraglutide, sitagliptin, and insulin glargine added to metformin: the effect on body weight and intrahepatic lipid in patients with type 2 diabetes mellitus and nonalcoholic fatty liver disease. Hepatology. 2019 Jun;69(6):2414-26.
9. Umpierrez GE, Pantalone KM, Kwan AY, Zimmermann AG, Zhang N, Fernández Landó L. Relationship between weight change and glycaemic control in patients with type 2 diabetes receiving once‐weekly dulaglutide treatment. Diabetes, Obesity and Metabolism. 2016 Jun;18(6):615-22.
10. Umpierrez GE, Skolnik N, Dex T, Traylor L, Chao J, Shaefer C. When basal insulin is not enough: A dose–response relationship between insulin glargine 100 units/mL and glycaemic control. Diabetes, Obesity and Metabolism. 2019 Jun;21(6):1305-10.
11. Wysham C, Bonadonna RC, Aroda VR, Puig Domingo M, Kapitza C, Stager W, Yu C, Niemoeller E, Souhami E, Bergenstal RM, LixiLan‐L trial investigators. Consistent findings in glycaemic control, body weight and hypoglycaemia with iGlarLixi (insulin glargine/lixisenatide titratable fixed‐ratio combination) vs insulin glargine across baseline HbA1c, BMI and diabetes duration categories in the LixiLan‐L trial. Diabetes, Obesity and Metabolism. 2017 Oct;19(10):1408-15.
12. Guo W, Tian W, Lin LU, Xu X. Liraglutide or insulin glargine treatments improves hepatic fat in obese patients with type 2 diabetes and nonalcoholic fatty liver disease in twenty-six weeks: a randomized placebo-controlled trial. Diabetes research and clinical practice. 2020 Dec 1;170:108487.
13. Aroda VR, Rosenstock J, Wysham C, Unger J, Bellido D, González-Gálvez G, Takami A, Guo H, Niemoeller E, Souhami E, Bergenstal RM. Efficacy and safety of LixiLan, a titratable fixed-ratio combination of insulin glargine plus lixisenatide in type 2 diabetes inadequately controlled on basal insulin and metformin: the LixiLan-L randomized trial. Diabetes care. 2016 Nov 1;39(11):1972-80.
14. Pan C, Gross JL, Yang W, Lv X, Sun L, Hansen CT, Xu H, Wagner R. A multinational, randomized, open-label, treat-to-target trial comparing insulin degludec and insulin glargine in insulin-naive patients with type 2 diabetes mellitus. Drugs in R&D. 2016 Jun;16:239-49.
15. McCrimmon RJ, Falla E, Sha JZ, Alsaleh AJ, Lew E, Hudson R, Baxter M, Palmer K. Cost-effectiveness of iGlarLixi in people with type 2 diabetes mellitus suboptimally controlled on basal insulin plus metformin in the UK. Diabetes Therapy. 2021 Dec;12:3217-30.
16. van Raalte DH, Verchere CB. Improving glycaemic control in type 2 diabetes: S timulate insulin secretion or provide beta‐cell rest?. Diabetes, Obesity and Metabolism. 2017 Sep;19(9):1205-13.
17. Rosenstock J, Aronson R, Grunberger G, Hanefeld M, Piatti P, Serusclat P, Cheng X, Zhou T, Niemoeller E, Souhami E, Davies M. Benefits of LixiLan, a titratable fixed-ratio combination of insulin glargine plus lixisenatide, versus insulin glargine and lixisenatide monocomponents in type 2 diabetes inadequately controlled on oral agents: the LixiLan-O randomized trial. Diabetes Care. 2016 Nov 1;39(11):2026-35.
18. Rosenstock J, Diamant M, Aroda VR, Silvestre L, Souhami E, Zhou T, Perfetti R, Fonseca V, LixiLan PoC Study Group. Efficacy and safety of LixiLan, a titratable fixed-ratio combination of lixisenatide and insulin glargine, versus insulin glargine in type 2 diabetes inadequately controlled on metformin monotherapy: the LixiLan proof-of-concept randomized trial. Diabetes Care. 2016 Sep 1;39(9):1579-86.
19. Yin TT, Bi Y, Li P, Shen SM, Xiong XL, Gao LJ, Jiang C, Wang Y, Feng WH, Zhu DL. Comparison of glycemic variability in Chinese T2DM patients treated with exenatide or insulin glargine: a randomized controlled trial. Diabetes Therapy. 2018 Jun;9:1253-67.
20. Taybani Z, Bótyik B, Katkó M, Gyimesi A, Várkonyi T. Simplifying complex insulin regimens while preserving good glycemic control in type 2 diabetes. Diabetes Therapy. 2019 Oct;10:1869-78.
21. Yuan X, Guo X, Zhang J, Dong X, Lu Y, Pang W, Gu S, Niemoeller E, Ping L, Nian G, Souhami E. Improved glycaemic control and weight benefit with iGlarLixi versus insulin glargine 100 U/mL in Chinese people with type 2 diabetes advancing their therapy from basal insulin plus oral antihyperglycaemic drugs: Results from the LixiLan‐L‐CN randomized controlled trial. Diabetes, Obesity and Metabolism. 2022 Nov;24(11):2182-91.