PMID- 23797471
OWN - NLM
STAT- MEDLINE
DCOM- 20140310
LR  - 20181202
IS  - 1865-8652 (Electronic)
IS  - 0741-238X (Linking)
VI  - 30
IP  - 6
DP  - 2013 Jun
TI  - Complementing insulin therapy to achieve glycemic control.
PG  - 557-76
AB  - INTRODUCTION: Most patients with type 2 diabetes mellitus (T2DM) will need 
      incrementally more complex therapeutic regimens to control hyperglycemia as the 
      disease progresses. Insulin is very effective in reducing hyperglycemia and may 
      improve beta-cell function in patients with T2DM. However, insulin therapy is 
      associated with weight gain and increased risk of hypoglycemia. Adding other 
      antidiabetes medications to insulin can improve glycemic control and potentially 
      lower the required insulin dose, resulting in less weight gain and lower risk for 
      hypoglycemia. This article summarizes the advantages and disadvantages of 
      different classes of commonly used antidiabetes agents, with emphasis on newer 
      classes, for use as add-on therapy to insulin in patients with T2DM inadequately 
      controlled on insulin therapy. METHODS: A PubMed search from July 1, 2003 to 
      April 15, 2013 for peer-reviewed clinical and review articles relevant to insulin 
      combination or add-on therapy in T2DM was conducted. Search terms included 
      "insulin combination therapy," "add-on therapy diabetes," "dipeptidyl peptidase-4 
      (DPP-4) inhibitors," "glucagon-like peptide-1 (GLP-1) receptor agonist," 
      "sodium-glucose cotransporter 2 (SGLT2) inhibitors", "insulin metformin," 
      "insulin sulfonylurea," and "insulin thiazolidinedione." Bibliographies from 
      retrieved articles were also searched for relevant articles. Study design, 
      clinical relevance, and effect on insulin combination therapy were analyzed. 
      RESULTS: Therapies used as add-on to insulin include agents associated with 
      weight gain (thiazolidinediones and sulfonylureas) and/or hypoglycemia 
      (sulfonylureas), which, therefore, may exacerbate risks already present with 
      insulin. GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT2 inhibitors improve 
      glycemic control when added to insulin and have a low propensity for hypoglycemia 
      and cause no change (DPP-4 inhibitors) or a reduction (GLP-1 receptor agonists, 
      SGLT2 inhibitors) in body weight. CONCLUSION: GLP-1 receptor agonists, DPP-4 
      inhibitors, and SGLT2 inhibitors improve glycemic control when combined with 
      insulin. They also have low propensity for weight gain and hypoglycemia and so 
      may be preferred treatment options for insulin combination when compared with 
      traditional therapies.
FAU - Barnett, Anthony H
AU  - Barnett AH
AD  - Diabetes Centre, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK. 
      Anthony.barnett@heartofengland.nhs.uk
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Adv Ther
JT  - Advances in therapy
JID - 8611864
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (GLP1R protein, human)
RN  - 0 (Glucagon-Like Peptide-1 Receptor)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 0 (Receptors, Glucagon)
RN  - 0 (Sodium-Glucose Transporter 2 Inhibitors)
RN  - 0 (Sulfonylurea Compounds)
RN  - 0 (Thiazolidinediones)
RN  - 9100L32L2N (Metformin)
MH  - Diabetes Mellitus, Type 2/*drug therapy
MH  - Dipeptidyl-Peptidase IV Inhibitors/*therapeutic use
MH  - Drug Therapy, Combination/methods
MH  - Glucagon-Like Peptide-1 Receptor
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Insulin/*therapeutic use
MH  - Metformin/therapeutic use
MH  - Receptors, Glucagon/agonists
MH  - Sodium-Glucose Transporter 2 Inhibitors
MH  - Sulfonylurea Compounds/*therapeutic use
MH  - Thiazolidinediones/*therapeutic use
EDAT- 2013/06/26 06:00
MHDA- 2014/03/13 06:00
CRDT- 2013/06/26 06:00
PHST- 2013/03/07 00:00 [received]
PHST- 2013/06/26 06:00 [entrez]
PHST- 2013/06/26 06:00 [pubmed]
PHST- 2014/03/13 06:00 [medline]
AID - 10.1007/s12325-013-0039-y [doi]
PST - ppublish
SO  - Adv Ther. 2013 Jun;30(6):557-76. doi: 10.1007/s12325-013-0039-y.