Diabetes Metab J.  2017 Jun;41(3):170-178. 10.4093/dmj.2017.41.3.170.

Comparison of Antidiabetic Regimens in Patients with Type 2 Diabetes Uncontrolled by Combination Therapy of Sulfonylurea and Metformin: Results of the MOHAS Disease Registry in Korea

• Choi SH
• Oh TJ
• Jang HC

• KMID: 2392491
• DOI: http://doi.org/10.4093/dmj.2017.41.3.170

Abstract

BACKGROUND
The aim of this study was to investigate the glucose-lowering efficacy of antidiabetic treatments in patients with type 2 diabetes mellitus (T2DM) uncontrolled by sulfonylurea plus metformin.
METHODS
This open-label, multicenter, prospective, observational study was conducted in 144 centers in Korea, from June 2008 to July 2010, and included patients with T2DM who had received sulfonylurea and metformin for at least 3 months and had levels of glycosylated hemoglobin (HbA1c) >7.0% in the last month. Data of clinical and biochemical characteristics were collected at baseline and 6 months after treatment. The treatment option was decided at the physician's discretion. Subjects were classified into the following three groups: intensifying oral hypoglycemic agents (group A), adding basal insulin (group B), or starting intensified insulin therapy (group C).
RESULTS
Of 2,995 patients enrolled, 2,901 patients were evaluated, and 504 (17.4%), 2,316 (79.8%), and 81 patients (2.8%) were classified into groups A, B, and C, respectively. Subjects in group C showed relatively higher baseline levels of HbA1c and longer duration of diabetes. The mean decrease in HbA1c level was higher in the insulin treated groups (−0.9%±1.3%, −1.6%±1.3%, and −2.4%±2.3% in groups A, B, and C, respectively, P=0.042). The proportion of patients who achieved target HbA1c <7.0% was comparable among the groups; however, intensified insulin therapy seemed to be the most effective in achieving the target HbA1c of 6.5%.
CONCLUSION
These findings suggest that insulin-based therapy will be an important option in the improved management of Korean patients with T2DM whose glycemic control is not sufficient with sulfonylurea and metformin.

Keyword

Diabetes mellitus, type 2; Insulin therapy; Oral hypoglycemic agent

MeSH Terms

Diabetes Mellitus, Type 2
Hemoglobin A, Glycosylated
Humans
Hypoglycemic Agents
Insulin
Korea*
Metformin*
Observational Study
Prospective Studies
Hypoglycemic Agents
Insulin
Metformin

Figure

• 

  Fig. 1 Study flow chart. Group A: intensifying oral hypoglycemic agents (OHAs; sulfonylurea+metformin dose titration or fixed-dose combination added to other OHAs). Group B: basal insulin alone or added to OHA mono/combination therapy. Group C: basal bolus, premixed insulin, and continuous subcutaneous insulin infusion alone or added to OHA mono/combination therapy. HbA1c, glycosylated hemoglobin.

• 

  Fig. 2 Change in (A) glycosylated hemoglobin (HbA1c) and (B) fasting plasma glucose (FPG). Group A: oral hypoglycemic agents (OHAs; sulfonylurea+metformin dose titration or fixed-dose combination added to other OHAs). Group B: basal insulin alone or added to OHA mono/combination therapy. Group C: basal insulin plus rapid acting insulin combination therapy alone or added to OHA mono/combination therapy. P value was calculated by analysis of covariance with adjustment of baseline HbA1c.

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