학술논문
Metformin-lnsulin versus Metformin-Sulfonylurea Combination Therapies in Type 2 Diabetes: A Comparative Study of Glycemic Control and Risk of Cardiovascular Diseases in Addis Ababa, Ethiopia
ORIGINAL RESEARCH
ORIGINAL RESEARCH
Document Type
Report
Source
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. July 31, 2021, Vol. 14, p3345, 15 p.
Subject
Language
English
ISSN
1178-7007
Abstract
Introduction Diabetes mellitus (DM) is one of the top ten causes of mortality and the fastest growing health emergencies of the 21st century, with 463 million people living with it [...]
Objective: This study aimed to compare glycemic control and risk of cardiovascular outcomes of metformin-insulin versus metformin-sulfonylurea combination therapies in type 2 diabetes mellitus. Methods: We conducted a comparative cross-sectional study in five tertiary level hospitals in Addis Ababa, Ethiopia. We enrolled 321 patients with type 2 diabetes mellitus who were on continuous treatment follow-up on either metformin-insulin or metformin-sulfonylurea combination therapy. We interviewed the participants and reviewed their medical records to investigate medication efficacy, safety, and adherence. The primary outcome measure was glycemic control and the secondary outcome measures were composite cardiovascular outcomes. Results: Of the total participants enrolled, 50.5% (n = 162) were those who received metformininsulin and 49.5% (n = 159) metformin-sulfonylurea combination therapies for a median of 48 months follow-up. The reduction of HblAc levels was comparable between the metformininsulin (-1.04 [+ or -] 0.96%) and metformin-sulfonylurea (-1.02 [+ or -] 1.03%), p = 0.912. Patients who received metformin-sulfonylurea had 4.3 times more likely to have achieved target HbAlc level compared to those who received metformin-insulin, p < 0.001, adjusted odds ratio (AOR) with 95% CI = 4.31[1.79--10.32]. Risk of composite cardiovascular outcomes was higher in metformin-insulin group (40.5% versus 34.0%), p = 0.021. Co-morbidities, body mass index, systolic blood pressure, and HbAlc had a significant association with composite cardiovascular outcomes. Reductions of bodyweight, HDL-C, LDL-C, triglycerides levels, and microvascular complications were different between the two groups, p < 0.05. Conclusion: High proportion of patients who received metformin-sulfonylurea achieved target HbAlc level and had less composite cardiovascular outcomes compared to those who received metformin-insulin. However, these findings have to be confirmed with randomized control trials to determine risks associated with insulin use, while efficacy is maintained as second-line treatment in patients with type 2 diabetes mellitus. Keywords: glycemic control, cardiovascular diseases, type 2 diabetes mellitus, metformin, insulin, sulfonylurea, glycated hemoglobin Ale (HbAlc)
Objective: This study aimed to compare glycemic control and risk of cardiovascular outcomes of metformin-insulin versus metformin-sulfonylurea combination therapies in type 2 diabetes mellitus. Methods: We conducted a comparative cross-sectional study in five tertiary level hospitals in Addis Ababa, Ethiopia. We enrolled 321 patients with type 2 diabetes mellitus who were on continuous treatment follow-up on either metformin-insulin or metformin-sulfonylurea combination therapy. We interviewed the participants and reviewed their medical records to investigate medication efficacy, safety, and adherence. The primary outcome measure was glycemic control and the secondary outcome measures were composite cardiovascular outcomes. Results: Of the total participants enrolled, 50.5% (n = 162) were those who received metformininsulin and 49.5% (n = 159) metformin-sulfonylurea combination therapies for a median of 48 months follow-up. The reduction of HblAc levels was comparable between the metformininsulin (-1.04 [+ or -] 0.96%) and metformin-sulfonylurea (-1.02 [+ or -] 1.03%), p = 0.912. Patients who received metformin-sulfonylurea had 4.3 times more likely to have achieved target HbAlc level compared to those who received metformin-insulin, p < 0.001, adjusted odds ratio (AOR) with 95% CI = 4.31[1.79--10.32]. Risk of composite cardiovascular outcomes was higher in metformin-insulin group (40.5% versus 34.0%), p = 0.021. Co-morbidities, body mass index, systolic blood pressure, and HbAlc had a significant association with composite cardiovascular outcomes. Reductions of bodyweight, HDL-C, LDL-C, triglycerides levels, and microvascular complications were different between the two groups, p < 0.05. Conclusion: High proportion of patients who received metformin-sulfonylurea achieved target HbAlc level and had less composite cardiovascular outcomes compared to those who received metformin-insulin. However, these findings have to be confirmed with randomized control trials to determine risks associated with insulin use, while efficacy is maintained as second-line treatment in patients with type 2 diabetes mellitus. Keywords: glycemic control, cardiovascular diseases, type 2 diabetes mellitus, metformin, insulin, sulfonylurea, glycated hemoglobin Ale (HbAlc)