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. 2020 Feb;28(2):210-214.
doi: 10.1016/j.jsps.2019.11.023. Epub 2019 Dec 7.

Comparative evaluation of biphasic insulin with metformin and triple oral hypoglycemic agents (OHA) in type 2 diabetes patients

Sirajudeen Shaik Alavudeen  1 , Moteb Khobrani  1 , C K Dhanapal  2 , Javid Iqbal Mir  1 , Sultan Mohammed Alshahrani  1 , Noohu Abdullah Khan  1 , Abdulaziz Alhossan  3
Affiliations

Comparative evaluation of biphasic insulin with metformin and triple oral hypoglycemic agents (OHA) in type 2 diabetes patients

Sirajudeen Shaik Alavudeen et al. Saudi Pharm J. 2020 Feb.

Abstract

Introduction: The prevalence of secondary failure to oral hypoglycemic agents among type 2 diabetes mellitus (T2DM) patients ranges from 30 to 60%. The alternative approaches to overcome this issue are either switching to triple oral hypoglycemic agents (OHA) or intensifying the regimen by adding insulin.

Objective: To compare the glycemic control achieved with biphasic insulin plus metformin and triple OHA in T2DM patients who were not adequately controlled with two OHA regimen.

Methods: A qualitative prospective study was conducted at Asir diabetes center, Abha, KSA. Poorly controlled T2DM patients with two OHA for at least 1 year with glycated hemoglobin (HbA1c) >7.0% were included. Subjects were divided into group I (a third OHA was added to the existing two OHA regimen) and group II (switched over to Biphasic insulin and metformin). At baseline and 3-month intervals, level of HbA1C, Fasting Plasma Glucose (FPG), Postprandial Plasma Glucose (PPG), Blood Pressure (BP), lipid profile and hypoglycemic episodes were obtained and evaluated for one year.

Results: 41.1% of patients were in group I and 58.9% were in group II. At the end of the study, there was a significant reduction in HbA1c in group II subjects comparing to group I (8.18 ± 1.32 vs 8.79 ± 1.81, p = 0.0238). FPG and PPG were improved also in group II. The mean body weight increased from baseline in group II is +4.48 kg and decreased from baseline in group I (-0.46 kg). 11.3% from group I and 23.7% from group II reported hypoglycaemic incidences.

Conclusion: Biphasic insulin and metformin regimen could be an appropriate therapeutic option for achieving good glycemic control compared with triple OHA in patients with two OHA failure.

Keywords: Biphasic insulin; Glycaemic control; Metformin; Oralhypoglycemic agents; Type 2 diabetes.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Temporal assessment of primary and secondary outcomes during the study period. Fig. 1a shows mean levels of glycosylated hemoglobin in the four study groups. Figure-1b shows mean levels of fasting plasma glucose. Figure-1c shows mean levels of postprandial blood glucose. Figure-1d shows mean levels of body weight. I bar denote standard deviation.
Fig. 2
Fig. 2
Mean changes in lipid profile from the baseline. Mean ± SD changes in HDL, LDL and triglyceride levels in the insulin plus metformin group as compared with thetripleOHA group.
See this image and copyright information in PMC

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