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Continuing metformin when starting insulin in patients with Type 2 diabetes: a double‐blind randomized placebo‐controlled trial
Author(s) -
Douek I. F.,
Allen S. E.,
Ewings P.,
Gale E. A. M.,
Bingley P. J.
Publication year - 2005
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2005.01475.x
Subject(s) - medicine , metformin , placebo , insulin , type 2 diabetes , diabetes mellitus , confidence interval , randomized controlled trial , weight gain , endocrinology , body weight , alternative medicine , pathology
Aims To test the effect of continuing metformin on weight gain and glycaemic control in patients with poorly controlled Type 2 diabetes who need to start insulin. Methods Patients with Type 2 diabetes on maximum tolerated oral agents referred for insulin conversion were recruited from hospital diabetes clinics into a double‐blind randomized placebo‐controlled trial. The 183 participants received metformin or placebo, titrated up to 2 g a day or maximum tolerated dose, with insulin started according to local practice. The main outcome measures were weight change over 12 months, HbA 1c , insulin dose, frequency of hypoglycaemia, treatment satisfaction, and well‐being. Results Over 12 months, metformin was associated with less weight gain than placebo [mean 6.1 kg vs. 7.6 kg; adjusted difference 1.5 kg (95% confidence interval 0.2–2.9); P = 0.02], a greater reduction in HbA 1c [1.5% vs. 1.3%; adjusted difference 0.5% (0.1–0.9); P = 0.02] and a lower insulin requirement [62 units vs. 86; adjusted difference 25 units (15–34); P < 0.001], but also more hypoglycaemia [relative risk of any episode 1.24 (1.02–1.1); P = 0.03]. Treatment satisfaction improved more in patients on metformin than on placebo ( P < 0.001), as did the positive well‐being score ( P = 0.02). Conclusions Metformin decreases weight gain, lowers insulin requirement, and improves glycaemic control, and should be continued in patients with Type 2 diabetes who transfer to insulin.