Should People with Diabetes Take Pills and/or Insulin?

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Janka HU, Plewe G, Riddle MC, et al. Comparison of basal insulin added to oral agents versus twice-daily premixed insulin as initial insulin therapy for type 2 diabetes. Diabetes Care 28:254­–259, 2005.

What is the problem and what is known about it so far?

When oral medications (pills) are no longer enough to keep blood glucose in check, doctors typically prescribe insulin that is taken as a shot. Sometimes doctors prescribe pills in addition to insulin and sometimes they prescribe just insulin. Doctors don't always agree on how or when people with diabetes should start taking insulin.

Researchers wanted to compare people who took both insulin and pills and people who take two insulin injections every day.

Who was studied?

The study included 371 people with type 2 diabetes who had never taken insulin. The patients were 35-75 years old, had diabetes for at least a year, and had taken pills for at least one month. All patients had poor control of their blood glucose with a fasting blood glucose level of 120 mg/dL or more and an A1C (a measure of long-term blood glucose control) level of 7.5-10.5% . Fasting blood glucose is a measure taken before a meal. Patients were recruited at 66 medical centers in 10 countries in Europe.

How was the study done?

Patients were randomly assigned to take a once-daily injection of slow-acting insulin plus pills (glargine plus OAD), or twice-daily injections of insulin (containing 30% regular and 70% NPH insulin).

What did the researchers find?

Patients who took insulin and pills had a much greater reduction in their long-term blood glucose control. Plus, more patients were able to reach the target level compared to those receiving two daily doses of insulin.

In addition, the average glucose level taken before a meal was lower in those patients taking insulin and pills. In addition, patients on both insulin and pills were more than twice as likely to reach target levels than the patients on insulin only.

What were the limitations of the study?

Researchers did not test other ways to take insulin and pills that could be even better for people with type 2 diabetes. Also, the researchers did not think about how much these treatments would cost patients.

What are the implications of the study?

Taking insulin and pills may be simpler, safer, and more effective than taking insulin twice a day.