Prescribing Advice for GPs

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Insulin vs. Glitazone as Third Line

A study published in Diabetes Care has examined triple therapy in diabetes with either insulin glargine or a glitazone (rosiglitazone).

The study was open label and conducted for 24 weeks. Patients were recruited to the study if they were taking more than half the maximum dose of metformin and a sulphonylurea and had a HcA1c between 7.5% and 11% and a BMI > 25Kg/M2.

Data were collected on HbA1c, fasting plasma glucose, weight gain and adverse events.

The patients did equally well in terms of HbA1c however there were differences in other parameters. Insulin glargine produced less weight gain, oedema and improved lipid levels at the expense of more hypoglycaemia. Insulin glargine was also calculated to be a lower cost intervention in this study.

Action: The third line agent choice in treatment of blood sugar in diabetes is still up for grabs. Needle phobic patients may prefer oral medication but the benefits of insulin appear broader in this study.

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