Continuation of metformin after introduction of insulin in type 2 diabetes

doi:10.1136/bmj.b4227

Published 9 November 2009, doi:10.1136/bmj.b4227
Cite this as: BMJ 2009;339:b4227

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Continuation of metformin after introduction of insulin in type 2 diabetes

Can prevent weight gain in non-obese patients and potentiallyimprove cardiovascular outcomes

The first 150 words of the full text of this article appear below.

Metformin is the cornerstone of treatment early in the courseof type 2 diabetes. Recent studies also provide evidence forthe benefits of metformin when given late in the course of thedisease, after the introduction of insulin.¹ ² However, becausemetformin targets insulin resistance in overweight patients,can it be as beneficial in non-obese patients?

In the linked randomised controlled trial (doi:10.1136/bmj.b4324),Lund and colleagues compare the effects of metformin versusrepaglinide in non-obese patients with type 2 diabetes treatedwith insulin.³ They randomised 102 patients (body mass index $≤$ 27 and glycated haemoglobin $≥$ 6.5), after a run-in period withcombined repaglinide and metformin, to receive either repaglinide6 mg plus insulin or metformin 2000 mg plus insulin. Patientshad been known to have diabetes for about 10 years. After 12months, they found no significant difference between the groupsin the primary outcome of glycaemic control—glycated haemoglobindecreased . . . [Full text of this article]

Adriaan Kooy, internist of vascular medicine

¹ Bethesda General Hospital and Bethesda Diabetes Research Centre, 7909 RA Hoogeveen, Netherlands

kooy.a@bethesda.nl

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