Report an error   
Advanced Search

INITIATE STUDY: Insulin versus Oral Hypoglycemic Agent as Initial Therapy for Newly Diagnosed Diabetes Mellitus Type 2: A Systematic Review and Meta-Analysis


Related Institution

Department of Medicine - St. Luke's Medical Center

Section of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine - St. Luke's Medical Center

Publication Information

Publication Type
Publication Sub Type
Journal Article, Original
Journal of the ASEAN Federation of Endocrine Societies
Publication Date
November 2014


Methodology. This is a systematic review and meta-analysis of RCTs with quality grade B searched using the medical subject headings (MeSH):  diabetes mellitus type 2, insulin, oral hypoglycemic agent, with adults newly diagnosed with type 2 DM as subjects and given insulin (± metformin) vs. OHA. Results were summarized as graphs and forest plots using the random effects due to foreseen sources of heterogeneity using Review Manager version 5.1. 

Results. Presence of substantial heterogeneity prevents us from making a conclusion. All four studies showed lower post treatment BMI among participants in the insulin treatment arm. An opposite finding was expected as insulin is known to cause weight gain.  Main adverse effect was hypoglycemia.

Conclusion.  Among newly diagnosed type 2 DM patients, there is insufficient evidence for or against the use of insulin compared to oral hypoglycemic agents as initial management in terms of improvement in glycemic control, decrease in insulin resistance, and improvement in beta cell function.

This study aims to evaluate the effectiveness of initial insulin therapy versus oral hypoglycemic agents in glucose control among newly diagnosed Type 2 diabetes patients.



This study aims to evaluate the effectiveness of initial insulin therapy versus oral hypoglycemic agents in glucose control among newly diagnosed Type 2 diabetes patients.



1. Diabetes Atlas Sixth Edition. International Diabetes Federation, 2013.
2. Garber, AJ , et al, . "AACE Comprehensive Diabetes Management Algorithm" Endocr Pract 19, 327-336, 2013
3. Chang-Chen, KJ , Mullur, R , Bernal-Mizrachi, E . "Beta-cell failure as a complication of diabetes" Rev Endocr Metab Disord 9(4): 329-43, December 2008. Retrieved from: http://dx.doi.org/10.1007/s11154-008-9101-5
4. Age-Adjusted Percentage of Adults with Diabetes Using Diabetes Medication, by Type of Medication, United States, 1997–2011. . Centers for Disease Control and Prevention (CDC), National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey 2013.
5. Shin, MS , et al, . "The Duration of Sulfonylurea Treatment Is Associated with β-Cell Dysfunction" Diabetes Technol Ther 14(11): 1033-42, November 2012. Retrieved from: http://dx.doi.org/10.1089/dia.2012.0144
6. Nathan, DM . "Initial management of glycemia in type 2 diabetes mellitus" N Engl J Med 347, 1342 -1349, 2002. Retrieved from: http://dx.doi.org/ 10.1056/NEJMcp021106
7. Ildiko, L , et al, . "Insulin-Based Versus Triple Oral Therapy for Newly Diagnosed Type 2 Diabetes: Which is better? " Diabetes Care 32(10): 1789-1795, October 2009. Retrieved from: http://dx.doi.org/10.2337/dc09-0653
8. Niswender, K , et al, . "Early and Aggressive Initiation of Insulin Therapy for Type 2 Diabetes: What Is the Evidence? Clinical Diabetes" Unmet Hearing Health Care Needs : The Beaver Dam Offspring Study 27(2): 60-68, 2009. Retrieved from: http://dx.doi.org/10.2337/diaclin.27.2.60
9. Turner, , et al, . (1993) Measurement of insulin resistance and β-cell function: the HOMA and CIGMA approach. Current topics in diabetes research (eds) F. Belfiore, R. Bergman and G. Molinatti Front Diabetes. Basel, Karger.. 66-75. (12)
10. "Executive Summary: Standards of medical care in diabetes-2010" Diabetes Care 33(Suppl 1): s4-s10, January 2010. Retrieved from: http://dx.doi.org/10.2337/dc10-S004
11. Prentki, M , Nolan, CJ . "Islet beta cell failure in type 2 diabetes" J Clin Invest 116, 1802–1812, 2006. Retrieved from: http://dx.doi.org/10.1172/JCI29103
12. Ryden, L , et al, . "ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboratio" Eur Heart J 34(39): 3035-3087, August 2013. Retrieved from: http://dx.doi.org/10.1093/eurheartj/eht108
13. Harrison, LB , et al, . "Beta-cell function preservation after 3.5 years of intensive diabetes therapy" Diabetes Care 35(7): 1406-1412, July 2012. Retrieved from: http://dx.doi.org/10.2337/dc11-2170
14. Hu, Y , Li, L , Xu, Y , et al, . "Short-term intensive therapy in newly diagnosed type 2 diabetes partially restores both insulin sensitivity and β-cell function in subjects with long-term remission" Diabetes Care 34(8): 1848-53, August 2011. Retrieved from: http://http:/dx/doi.org/10.2337/dc10-2105
15. Joya-Galeana, J , et al, . "Effects of insulin and oral anti-diabetic agents on glucose metabolism, vascular dysfunction and skeletal muscle inflammation in type 2 diabetic subjects" Diabetes/Metabolism Research and Reviews 27(4): 373-382, 2011. Retrieved from: http://dx.doi.org/ 10.1002/dmrr.1185
16. Turner, RC , et al, . "Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: Progressive requirement for multiple therapies (UKPDS 49)" JAMA 281(21): 2005-2012, June 1999. Retrieved from: http://dx.doi.org/ 10.1001/jama.281.21.2005
17. Chen, HS , et al, . "Beneficial effects of insulin on glycemic control and beta cell function in newly diagnosed type 2 diabetes with severe hyperglycemia after short term intensive insulin therapy" Diabetes Care 31(10): 1927-1932, October 2008. Retrieved from: http://dx.doi.org/10.2337/dc08-0075
18. Weng, J , et al, . "Effect of intensive insulin therapy on beta cell function and glycemic control in patients with newly diagnosed type 2 diabetes: A multicenter randomized parallel-group trial" Lancet 371, 1753-1760, May 2008. Retrieved from: http://dx.doi.org/10.1016/S0140-6736(08)60762-X

Physical Location

LocationLocation CodeAvailable FormatAvailability
http://www.asean-endocrinejournal.org Fulltext External Link (View)

©2022 HERDIN PLUS. All rights reserved. | Contact Us | Keep up to date