Objective: Early use of insulin after diagnosis of type 2 diabetes is met with resistance because of associated weight gain, hypoglycemia, and fear of decreased compliance and quality of life QoL. Research design and methods: In treatment-naive patients with newly diagnosed type 2 diabetes, insulin and metformin were initiated for a 3-month lead-in period, then patients were randomly assigned to insulin and metformin insulin group or metformin, pioglitazone, and glyburide oral group for 36 months. Hypoglycemic events, compliance, A1C, weight, QoL, and treatment satisfaction were assessed. At study completion, A1C was 6. Hypoglycemic events did not differ between groups mild 0.

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Aims: To compare the effects of initiating insulin as a fourth-line antidiabetic therapy with the effects of enhancing oral antidiabetic drug OAD therapy in patients with type 2 diabetes mellitus T2DM with triple OAD therapy failure. Clinical outcomes including a composite cardiovascular outcome myocardial infarction, stroke, heart failure or ischaemic heart disease , peripheral vascular disease PVD , hypoglycaemia and all-cause mortality were assessed up to Hypoglycaemia was adjusted in Cox models to consider its potential effect on study outcomes. Conclusions: Initiation of fourth-line insulin therapy can be considered for patients with T2DM with triple OAD therapy failure, and the importance of awareness and prevention of hypoglycaemia among insulin-treated patients with T2DM cannot be overstated. Keywords: antidiabetic drug; cardiovascular disease; cohort study; hypoglycaemia; insulin therapy; type 2 diabetes. Abstract Aims: To compare the effects of initiating insulin as a fourth-line antidiabetic therapy with the effects of enhancing oral antidiabetic drug OAD therapy in patients with type 2 diabetes mellitus T2DM with triple OAD therapy failure. Publication types Research Support, N. Substances Hypoglycemic Agents Insulin.
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