Combination insulin and sulfonylurea therapy in insulin-requiring type 2 diabetes mellitus

Japanese Clinical Practice Guideline for Diabetes 2019

“…[Q6‐7] What are the indications/approaches for insulin therapy in type 2 diabetes? Insulin therapy is to be implemented in patients with type 2 diabetes having inadequate glycemic control despite MNT, increased physical activity/exercise and treatment with non‐insulin glucose‐lowering agents 3,8–10 . While injection of once‐daily long‐acting insulin or twice‐daily premixed insulin (morning and evening) may be sufficient to provide favorable glycemic control in patients with mild diabetes, intensive insulin therapy with multiple insulin injections is to be implemented in those with moderate‐to‐severe diabetes 8,11,12 . Combination therapy with insulin and oral glucose‐lowering agents (SUs 13,14 , fast‐acting insulin secretagogues [glinides] 15–17 ), biguanides 18–21 , α‐glucosidase inhibitors 22,23 , insulin sensitizers 24–27 , and, DPP‐4 inhibitors 28 , and SGLT2 inhibitors 29 or GLP‐1 receptor agonists 30 are shown to improve glycemic control and reduce the insulin dose being used in patients with type 2 diabetes. …”

Accuracy of continuous nocturnal glucose monitoring after 48 and 72 hours in type 2 diabetes patients on combined oral and insulin therapy

“…They concluded that, compared to insulin monotherapy, combination therapy improved glycaemic control with fewer exogenous insulin doses. Many investigators have documented the efficacy of insulin and SU therapy, showing better HbA 1c with combination therapy [Shank et al 1995;Feinglos et al 1998;Janka et al 2007;Ebato et al 2009].…”

“…The results showed significant reduction in HbA 1c three months after glimepiride addition even though insulin doses had to be reduced in approximately 50 % of the patients. Adding SU to insulin therapy was investigated in another placebo-controlled cross-over study, where the patients had a mean diabetes duration of 15 years and an insulin requirement of ≥ 40 U/day [Feinglos et al 1998]. Glipizide addition resulted in a rapid and substantial improvement in glycaemic control despite significant insulin dose reductions in the insulin + glipizide group.…”

A randomized controlled trial examining combinations of repaglinide, metformin and NPH insulin

“…Evidence with respect to combination therapy using sulphonylureas and insulin is less clear. The literature consistently suggests decreased insulin requirement and similar hypoglycaemic rates along with variable effects for improvement in HbA 1c and gain in weight [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. A large meta-analysis which compared insulin in combination with continued sulphonylurea use [28] found that the fall in mean HbA 1c was greater in the sulphonylurea group compared with insulin monotherapy (1.1% vs. 0.25%) along with a greater fall in mean insulin dose (12 U/day vs. 1 U/day).…”