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Comparative Study
. 2024 Nov 21;19(11):e0311435.
doi: 10.1371/journal.pone.0311435. eCollection 2024.

Comparing dual oral agents plus insulin vs. Triple oral agents in uncontrolled type II diabetes: A pilot study

Nadia Gul  1 , Inayat Ur Rehman  1   2 , Yasar Shah  1 , Arbab Muhammad Ali  3 , Zahid Ali  4 , Omer Shehzad  1 , Khang Wen Goh  5 , Long Chiau Ming  6 , Amal K Suleiman  7
Affiliations
Comparative Study

Comparing dual oral agents plus insulin vs. Triple oral agents in uncontrolled type II diabetes: A pilot study

Nadia Gul et al. PLoS One. .

Abstract

Introduction: Type II Diabetes mellitus (T2DM) patients often do not achieve glycemic control with oral hypoglycemic agents (OHAs). There are two main approaches to address this challenge: transitioning to a triple OHA regimen, or adding Insulin to the existing dual OHA regimen.

Aim: This study aimed to compare the efficacy of adding Insulin to dual OHAs (Sitagliptin + Metformin) against adding a third OHA to Sitagliptin + Metformin in achieving glycemic control among patients with uncontrolled T2DM.

Method: A pre-post study was conducted between 21 September 2023 and 21 December 2023 at Services Hospital Peshawar, Pakistan. Patients with uncontrolled T2DM with >7% HbA1c were divided into group 1 (Sitagliptin + Metformin plus a third OHA), and group 2 (Sitagliptin + Metformin plus pre-mixed Insulin 70/30). Glycemic control based on HbA1c values, fasting and random blood sugar levels, lipid profile, and body weight were evaluated after 3 months of therapy. The pre- and post- effect was compared by using a paired t-test.

Results: The study included n = 80 patients with T2DM. Between groups 1 and 2, no significant difference was found in HbA1c values (9.1 vs. 9, with p = 0.724). However, BMI, cholesterol, and LDL significantly decreased in group 1 compared to group 2 (p<0.001 vs. p = 0.131, p = 0.023 vs. p = 0.896, and p = 0.003 vs. p = 0.395, respectively). Additionally, the incidence of hypoglycemic episodes was significantly lower in group 1 (7.5%) than in group 2 (47.5%, p = 0.004). No significant difference was observed between the triple OHA and dual OHA plus Insulin regimens in achieving glycemic control.

Conclusion: The triple OHA regimen improved BMI, cholesterol, and LDL levels, and reduced hypoglycemic episodes more effectively than dual OHA plus Insulin, despite similar HbA1c outcomes, suggesting it may be preferable for uncontrolled T2DM.

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Conflict of interest statement

All authors declare no financial and conflict of interest.

Figures

Fig 1
Fig 1. Flow chart of patient’s recruitment and participation.
Fig 2
Fig 2. Impact of group 1 and group 2 drugs on hyperglycemia based on HbA1c levels before and after 3 months of administration.
Fig 3
Fig 3. Frequency of hypoglycemic episodes in group 1 vs group 2.
See this image and copyright information in PMC

References

    1. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al.. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas. Diabetes research and clinical practice. 2019;157:107843. - PubMed
    1. Kumar A, Gangwar R, Ahmad Zargar A, Kumar R, Sharma A. Prevalence of diabetes in India: A review of IDF diabetes atlas 10th edition. Current diabetes reviews. 2024;20(1):105–14. doi: 10.2174/1573399819666230413094200 - DOI - PubMed
    1. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al.. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes research and clinical practice. 2022;183:109119. doi: 10.1016/j.diabres.2021.109119 - DOI - PMC - PubMed
    1. Bai J, Shi F, Ma Y, Yang D, Yu C, Cao J. The global burden of type 2 diabetes attributable to tobacco: a secondary analysis from the global burden of disease study 2019. Frontiers in Endocrinology. 2022;13:905367. doi: 10.3389/fendo.2022.905367 - DOI - PMC - PubMed
    1. Wang T, Zhao Z, Wang G, Li Q, Xu Y, Li M, et al.. Age-related disparities in diabetes risk attributable to modifiable risk factor profiles in Chinese adults: a nationwide, population-based, cohort study. The Lancet Healthy Longevity. 2021;2(10):e618–e28. doi: 10.1016/S2666-7568(21)00177-X - DOI - PubMed

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