Insulin or Sulfonylureas to Supplement Metformin in Patients with Diabetes?

Metformin and lifestyle modifications are the mainstay of initial treatment for patients with type 2 diabetes. The choice of a second medication for patients who do not achieve full control with this regimen is unclear. Investigators conducted a retrospective cohort study in the Veterans Affairs healthcare system and identified patients who had initiated metformin and then received either insulin or a sulfonylurea to achieve better glycemic control between 2001 and 2008. About 12,000 sulfonylurea recipients and about 2500 insulin recipients were matched closely for many demographic and clinical covariates through propensity scores. Median age was 60, and median glycosylated hemoglobin (HbA_1c) level was 8.1% in both groups.

The combined endpo…