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A randomized controlled trial examining combinations of repaglinide, metformin and NPH insulin
Author(s) -
Davies M. J.,
Thaware P. K.,
Tringham J. R.,
Howe J.,
Jarvis J.,
Johnston V.,
Kitchener D. L.,
Skinner T. C.,
McNally P. G.,
Lawrence I. G.
Publication year - 2007
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.1464-5491.2007.02128.x
Subject(s) - repaglinide , medicine , metformin , bedtime , nph insulin , insulin , type 2 diabetes , endocrinology , diabetes mellitus , randomized controlled trial , hypoglycemia , insulin glargine
Abstract Aims To compare combination use of repaglinide, metformin and bedtime Neutral Protamine Hagedorn (NPH) insulin with conventional approaches of insulin initiation in patients with Type 2 diabetes (T2DM). Methods Eighty‐two patients with T2DM with suboptimal glycaemic control on oral glucose‐lowering agents were randomized to one of three treatment regimens for 4 months. Group 1 received metformin and twice daily biphasic 30/70 human insulin mixture ( n = 27), group 2 metformin and bedtime NPH insulin ( n = 26) and group 3 metformin, bedtime NPH insulin and mealtime repaglinide ( n = 25). Results Seventy‐five patients completed the study. Baseline and end‐point mean HbA 1c levels fell from 9.0 ± 1.1 to 7.9 ± 1.1% in group 1, 10.0 ± 2.2 to 9.2 ± 1.4% group 2 and 10.0 ± 1.7 to 8.1 ± 1.5% in group 3, respectively. All groups showed improvements in HbA 1c . There was no significant difference between groups in the proportions of patients experiencing hypoglycaemia (29.6, 25.0 and 16.7%, respectively; P = 0.55) or in mean weight gain (2.9, 0.7 and 2.2 kg, respectively; P = 0.06). By 4 months, insulin doses were 0.63 ± 0.32 IU/kg in group 1, 0.58 ± 0.21 IU/kg in group 2 and 0.37 ± 0.22 IU/kg in group 3 (group 3 vs. groups 1 and 2: P < 0.002). Conclusions The approach using repaglinide, metformin and NPH insulin improved glycaemic control with a similar safety profile to conventional insulin initiation in T2DM and produced final glycaemic control similar to metformin and a twice daily biphasic insulin mixture.