Insulin vs. Oral Therapy for Newly Diagnosed Type 2 Diabetes

For patients with newly diagnosed type 2 diabetes, clinicians typically start treatment with oral agents and add insulin only if glycemic control remains inadequate after prolonged multidrug oral therapy. In a trial involving 58 such patients (mean glycosylated hemoglobin [HbA_1c] levels at diagnosis, 10.8%), researchers compared early insulin therapy and triple oral therapy.

After a 3-month run-in period during which all patients received insulin and metformin to normalize HbA_1c levels, patients were randomized to receive insulin (NovoLog mix 70/30, twice daily) plus metformin or a combination of metformin, glyburide, and pioglitazone. At 3 years, mean HbA_1c level was 6% in both groups. Mean weight gain was slightly more with triple oral the…