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Difference Between Insulin And Metformin

Insulin Vs. Metformin Treatment

Insulin Vs. Metformin Treatment

Diabetes affected 7.8 percent of the American population in 2007. Diabetes has several causes. Type 1 diabetes, previously called juvenile diabetes, caused by failure of the pancreas to produce insulin, affects 5 percent to 10 percent of people with diabetes, while Type 2 diabetes, previously called adult-onset diabetes, accounts for most of the rest, according to the National Institute of Diabetes and Digestive and Kidney Disorders. Different drugs are used to treat diabetes, depending on the cause and severity of the disease. Insulin, an injectable medication, and metformin, an oral medication, have different actions. Video of the Day The purpose of both insulin and metformin is to lower blood glucose levels. Insulin injections replace the insulin your body can no longer make when the cells in the pancreas cease to function. Metformin is an oral hypoglycemic, which lowers blood glucose levels by decreasing the liver’s output of glucose. Metformin also increases insulin sensitivity, and improves not only blood glucose levels but also lipid levels and often results in weight loss. Of all diabetics, 14 percent take insulin only, 57 percent take oral medications only and 14 percent take a combination of both, the NIDDK reports. Oral hypoglycemics are used only in Type 2 diabetes, because Type 1 diabetics make little or no insulin, so reducing the glucose levels produced by the liver won’t reduce blood glucose levels. Without insulin, glucose can’t enter cells and remains in the bloodstream. While all Type 1 diabetics take insulin, some Type 2 diabetics also need insulin in addition or instead of oral hypoglycemics such as metformin. Insulin, which must be injected, comes in several forms and doses, and can have rapid or slow onset. Diarrhea, the most common side eff Continue reading >>

Insulin Usually Better Than Oral Drugs For Type 2 Diabetes

Insulin Usually Better Than Oral Drugs For Type 2 Diabetes

According to a study published in , the combination of insulin and metformin may not benefit individuals with type 2 diabetes. Although the combination results in less weight gain, improved blood glucose control and less need for insulin, the researchers state that further research is required in order to provide solid evidence regarding the benefits and harms, as well as the risks of premature death. The study was conducted by researchers from the Copenhagen Trial Unit, Steno Hospital and the Copenhagen University Hospital. At present, guidelines recommend metformin, an oral blood glucose reducing medication, for type 2 diabetics starting insulin treatment. The researchers examined 2,217 individuals aged 18+ with type 2 diabetes. Among the trials examined, the team found insufficient reports of important patient outcomes, such as total mortality and death from heart disease. According to 20 trials, levels of HbA1c (a measure of average blood glucose levels over time) were reduced when insulin and metformin was taken together. Furthermore, the researchers found that the combination of drugs considerably reduced weight gain and body mass index (BMI) by an average of 1.6 kg. The researchers state that additional studies are required in order to research the long term benefits and harms of the combination, as it increases the risk of severe hypoglycaemic attack. In this week's BMJ podcast, Trish Groves, the deputy editor of BMJ, talks to lead author Bianca Hemmingsen about how this study was able to draw on more data than prior studies, and how the researchers examined major complications and mortality instead of surrogate outcomes, such as blood sugar levels and weight. In addition, Dr. Hemmingsen highlights the insufficient evidence for determining if the combination or Continue reading >>

Evaluation Of Metformin Versus Insulin In The Management Of Gestational Diabetes Mellitus: A Prospective Comparative Study

Evaluation Of Metformin Versus Insulin In The Management Of Gestational Diabetes Mellitus: A Prospective Comparative Study

Evaluation of metformin versus insulin in the management of gestational diabetes mellitus: a prospective comparative study Pregnancy is a potentially glucose intolerant condition. Insulin sensitivity decreases as the pregnancy advances. Of these women, some will develop Gestational Diabetes Mellitus (GDM) due to inadequate insulin secretion, particularly in obese women with pre-existing insulin GDM is diagnosed in approximately 3-7% of pregnancies.2,3 The incidence of GDM increases in older and more obese pregnant women. GDM increases the risk of certain pregnancy complications like pregnancy induced hypertension and adverse perinatal outcome, it carries the risk of later development of type 2 diabetes Prospective randomized controlled trials have recently demonstrated that effective treatment of hyperglycemia in women with GDM can reduce adverse perinatal outcomes.5 The main purpose of treatment is to prevent hyperinsulinemia and fetal macrosomia by reducing maternal glucose levels.6 This is initially attempted by dietary and exercise counseling, but women often require additional treatment, which has traditionally been insulin. pharmacological treatment varies from 20-60% in various studies.7 However, the disadvantages of insulin in 1Department of Obstetrics & Gynecology, NRS Medical College, Entally, Kolkata-700014, West Bengal, India 2Department of Obstetrics & Gynecology, North Bengal Medical College, Sushrutanagar, Darjeeling-734012, West Munshi S et al. Int J Reprod Contracept Obstet Gynecol. 2014 Jun;3(2):357-361 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 3 Issue 2 Page 358 pregnant women, includes the risk of hypoglycemia, appreciable weight gain and repeated insulin injections. Theoretically, metformin is an alterna Continue reading >>

Combination Of Insulin And Metformin In The Treatment Of Type 2 Diabetes

Combination Of Insulin And Metformin In The Treatment Of Type 2 Diabetes

Abstract OBJECTIVE—To investigate the metabolic effects of metformin, as compared with placebo, in type 2 diabetic patients intensively treated with insulin. RESEARCH DESIGN AND METHODS—Metformin improves glycemic control in poorly controlled type 2 diabetic patients. Its effect in type 2 diabetic patients who are intensively treated with insulin has not been studied. A total of 390 patients whose type 2 diabetes was controlled with insulin therapy completed a randomized controlled double-blind trial with a planned interim analysis after 16 weeks of treatment.The subjects were selected from three outpatient clinics in regional hospitals and were randomly assigned to either the placebo or metformin group, in addition to insulin therapy. Intensive glucose monitoring with immediate insulin adjustments according to strict guidelines was conducted. Indexes of glycemic control, insulin requirements, body weight, blood pressure, plasma lipids, hypoglycemic events, and other adverse events were measured. RESULTS—Of the 390 subjects, 37 dropped out (12 in the placebo and 25 in the metformin group). Of those who completed 16 weeks of treatment, metformin use, as compared with placebo, was associated with improved glycemic control (mean daily glucose at 16 weeks 7.8 vs. 8.8 mmol/l, P = 0.006; mean GHb 6.9 vs. 7.6%, P < 0.0001); reduced insulin requirements (63.8 vs. 71.3 IU, P < 0.0001); reduced weight gain (−0.4 vs. +1.2 kg, P < 0.01); and decreased plasma LDL cholesterol (−0.21 vs. −0.02 mmol/l, P < 0.01). Risk of hypoglycemia was similar in both groups. CONCLUSIONS—In type 2 diabetic patients who are intensively treated with insulin, the combination of insulin and metformin results in superior glycemic control compared with insulin therapy alone, while insulin req Continue reading >>

Comparison Of Metformin And Insulin Versus Insulin Alone For Type 2 Diabetes: Systematic Review Of Randomised Clinical Trials With Meta-analyses And Trial Sequential Analyses

Comparison Of Metformin And Insulin Versus Insulin Alone For Type 2 Diabetes: Systematic Review Of Randomised Clinical Trials With Meta-analyses And Trial Sequential Analyses

Comparison of metformin and insulin versus insulin alone for type 2 diabetes: systematic review of randomised clinical trials with meta-analyses and trial sequential analyses Comparison of metformin and insulin versus insulin alone for type 2 diabetes: systematic review of randomised clinical trials with meta-analyses and trial sequential analyses BMJ 2012; 344 doi: (Published 19 April 2012) Cite this as: BMJ 2012;344:e1771 Christian Gluud, chief physician and head of department 1 , Thomas Almdal, chief physician and head of department 4 1Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen, Denmark 2Department of Paediatrics, Hvidovre University Hospital, Hvidovre, Denmark 3Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital 4Steno Diabetes Centre, Gentofte, Denmark Correspondence to: B Hemmingsen bh{at}ctu.rh.dk Objectives To compare the benefits and harms of metformin and insulin versus insulin alone as reported in randomised clinical trials of patients with type 2 diabetes. Design Systematic review of randomised clinical trials with meta-analyses and trial sequential analyses. Data sources The Cochrane Library, Medline, Embase, Science Citation Index Expanded, Latin American Caribbean Health Sciences Literature, and Cumulative Index to Nursing and Allied Health Literature until March 2011. We also searched abstracts presented at the American Diabetes Association and European Association for the Study of Diabetes Congresses, contacted relevant trial authors and pharmaceutical companies, hand searched reference lists of included trials, and searched the US Food and Drug Administration website. Review methods Two authors independently screened titles and abstracts f Continue reading >>

Metformin (glucophage®) Versus Insulin

Metformin (glucophage®) Versus Insulin

Metformin Insulin Brand name/Year of initial approval Glucophage®, 1995 Humalog®, NovoLog®, NovoRapid®, Lantus® Formulations Oral tablets, Extended-release tablets Subcutaneous injection Drug class Antidiabetic agent Biguanide Human insulin analog FDA-approved Indications • Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus • Type 1 diabetes mellitus • Type 2 diabetes mellitus Off-label uses • Gestational diabetes • Prediabetes • Type I diabetes Mechanism of action • Decreases hepatic glucose production • Improves insulin sensitivity (increases peripheral glucose uptake and utilization) • Reduce absorption of glucose in the gut • Regulates glucose metabolism: stimulates peripheral glucose uptake by skeletal muscle and fat, and inhibits hepatic glucose production. Oral bioavailability 50-60% 55-77% Metabolism, Elimination Metformin is not metabolized and is excreted unchanged by the kidneys Identical to regular human insulin Contraindications • Hypersensitivity to metformin • Metabolic acidosis • Renal dysfunction (serum creatinine levels ≥ 1.4 mg/dL or abnormal creatinine clearance) • Hypersensitivity to insulin Warnings & precautions • Possible risk of lactic acidosis • Kidney injury, hepatic dysfunction, conditions associated with hypoxia are risk factors for lactic acidosis • Hypoglycemia - the most common adverse reaction, may be life-threatening • Severe, life-threatening hypersensitivity reactions can occur • Risk of hypokalemia Side effects • Gastrointestinal side effects: diarrhea, nausea, flatulence, abdominal discomfort • Decreased absorption of Vitamin B 12 and folic acid • Hypoglycemia • Weight gain • Lipodystrophy at the site of repeated injections • Edema Continue reading >>

A Comparison Of Treatment With Metformin And Gliclazide In Patients With Non-insulin-dependent Diabetes.

A Comparison Of Treatment With Metformin And Gliclazide In Patients With Non-insulin-dependent Diabetes.

A comparison of treatment with metformin and gliclazide in patients with non-insulin-dependent diabetes. McAlpine LG, et al. Eur J Clin Pharmacol. 1988. Diabetic Department, Gartnavel General Hospital, Glasgow, U.K. Twenty-seven obese non-insulin-dependent diabetic patients, treated with dietary carbohydrate restriction and metformin, were recruited from the diabetic outpatient clinic and entered into an open crossover study with gliclazide. Twenty-one patients completed the study. During three months observation on metformin, the mean weight of the group fell by 1.0 kg with 14 patients losing a mean of 1.8 kg with 14 patients losing a mean of 1.8 kg, 3 remaining unchanged and 4 gaining a mean weight of 1.1 kg. Over the subsequent three months on gliclazide, the mean weight of the group rose by 1.4 kg with 16 patients gaining a mean of 2.2 kg, two remaining unchanged and 3 losing a mean of 2.0 kg. In addition, 10 patients were heavier after gliclazide than at the time of recruitment (mean 2.6 kg), 3 were unchanged and 8 had lost weight since commencing the trial (mean 2.1 kg), mostly due to greater loss on metformin than gain on gliclazide. Glycaemic control did not improve significantly during the observed period on metformin but lower concentrations of fasting glucose and total glycosylated haemoglobin were achieved with gliclazide. Mean plasma insulin concentration was significantly higher and mean serum lactate was significantly lower during treatment with gliclazide. In conclusion, gliclazide does not support weight loss in obese non-insulin-dependent diabetic patients to the same extent as metformin but the difference between the two drugs is small. Gliclazide is a suitable oral hypoglycaemic agent for use in the obese diabetic who cannot be controlled by diet al Continue reading >>

Metformin Vs Insulin

Metformin Vs Insulin

Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Sounds like a ridiculous question but Metformin works on the Liver and Insulin provides additional stuffs to break down sugar. My big question is that why would the Doctor put you on a second pill that pushes the Pancreas to work harder thus burning it out vis using insulin to give your pancreas a break. I think if Metformin stops working I will look at other avenues before overworking the pancreas such as insulin as obviously Insulin could allow the pancreas time to re-charge and having them both work together might be best. The battery (Pancreas) happly works when needed but its seems when the battery (Pancreas) starts becoming depleted the battery is drained quicker with medications that force it to work harder until it is spent. I am not against the idea of Insulin even though my T2 is relatively mild as it means I am lessening the strain on my pancreas to make up for it which should stop beta cell death. Not me. I have plenty of my own insulin. Injecting more wouldn't stop the pancreas producing its own and would be counter productive, especially where insulin resistance is an issue. It isn't the lack of insulin that is the problem with most T2s. it is the insulin resistance. The cells are blocking the insulin, so you end up with excess insulin floating about, and as this is a fat carrying hormone, you put weight on thus causing more insulin resistance. Vicious circle. The less insulin in your body, the better. T2D is often caused by a resistance to Insulin. Injecting Insulin will be unlikely to help with this resistance, and will likely make it worse. Of course if your T2D is not mainly due to Insulin resistance then the above is incorrect. My u Continue reading >>

Combination Therapy With Insulin And Metformin.

Combination Therapy With Insulin And Metformin.

Abstract OBJECTIVE: To review the clinical usefulness of combination therapy with insulin and metformin. METHODS: Basic considerations about the use of insulin in non-insulin-dependent diabetes mellitus (NIDDM) and the interaction of metformin with insulin are outlined. The clinical documentation of this therapeutic strategy is reviewed, with emphasis on controlled studies. In addition, the use of this drug combination in insulin-dependent diabetes mellitus (IDDM) is briefly addressed. RESULTS: Insulin is used in patients with NIDDM when adequate plasma glucose control can no longer be maintained by orally administered agents. Metformin ameliorates insulin resistance, reduces hyperinsulinemia, and counteracts weight gain. It exerts an insulin-sparing and antihyperglycemic effect and may improve cardiovascular risk factors. Although these effects have been demonstrated consistently in several controlled studies, relatively few patients have been treated with insulin + metformin (with or without sulfonylurea). The combination is well tolerated, commonly used, and approved in several countries. No specific guidelines have been established for selection of patients, but obese patients with NIDDM who are receiving high doses of insulin are likely to benefit. Patients whose diabetes is poorly controlled by sulfonylurea or by combination oral therapy, not previously treated with insulin, may also be suitable candidates. Insulin administered at bedtime is a feasible approach, and a daily dose of 1.5 to 2.5 g of metformin seems adequate. Although the application may be questionable, metformin can also be added to insulin in the treatment of selected patients with IDDM. CONCLUSION: Metformin is effective in conjunction with insulin in NIDDM. Because of its action on insulin resis Continue reading >>

Effect Of Pioglitazone Compared With Metformin On Glycemic Control And Indicators Of Insulin Sensitivity In Recently Diagnosed Patients With Type 2 Diabetes

Effect Of Pioglitazone Compared With Metformin On Glycemic Control And Indicators Of Insulin Sensitivity In Recently Diagnosed Patients With Type 2 Diabetes

Pioglitazone, a thiazolidinedione, improves glycemic control primarily by increasing peripheral insulin sensitivity in patients with type 2 diabetes, whereas metformin, a biguanide, exerts its effect primarily by decreasing hepatic glucose output. In the first head-to-head, double-blind clinical trial comparing these two oral antihyperglycemic medications (OAMs), we studied the effect of 32-wk monotherapy on glycemic control and insulin sensitivity in 205 patients with recently diagnosed type 2 diabetes who were naive to OAM therapy. Subjects were randomized to either 30 mg pioglitazone or 850 mg metformin daily with titrations upward to 45 mg (77% of pioglitazone patients) and 2550 mg (73% of metformin patients), as indicated, to achieve fasting plasma glucose levels of less than 7.0 mmol/liter (126 mg/dl). Pioglitazone was comparable to metformin in improving glycemic control as measured by hemoglobin A1C and fasting plasma glucose. At endpoint, pioglitazone was significantly more effective than metformin in improving indicators of insulin sensitivity, as determined by reduction of fasting serum insulin (P = 0.003) and by analysis of homeostasis model assessment for insulin sensitivity (HOMA-S; P = 0.002). Both OAM therapies were well tolerated. Therefore, pioglitazone and metformin are equally efficacious in regard to glycemic control, but they exert significantly different effects on insulin sensitivity due to differing mechanisms of action. The more pronounced improvement in indicators of insulin sensitivity by pioglitazone, as compared with metformin monotherapy in patients recently diagnosed with type 2 diabetes who are OAM-naive, may be of interest for further clinical evaluation. Most studies of sex hormones and insulin resistance (IR) have focused on androgens Continue reading >>

Compare Metformin Vs. Lantus

Compare Metformin Vs. Lantus

Lowers blood sugar. Glucophage (metformin) is the first choice medicine to control your blood sugar and lower the risk of death from diabetes, although a few people may not tolerate the stomach side effects. Improves sugar control and lowers A1c levels as much as 2%. One of the few diabetes medicines that lowers the risk of death from diabetes-related complications. Rarely causes low blood sugar. Insulin is one of the most effective blood sugar-lowering medication and can lower your A1c (average blood sugar over time) by up to 2-3%. Lantus (insulin glargine) is a long-lasting insulin that provides consistent, all-day sugar control with just once or twice daily dosing. Dose can be easily adjusted to make a customized regimen that's tailored to your body's needs. Lantus (insulin glargine) can be used with liver or kidney problems. 938 reviews so far Have you used Glucophage (metformin)? Leave a review 584 reviews so far Have you used Lantus (insulin glargine)? Leave a review Continue reading >>

Insulin 70/30 Mix Plus Metformin Versus Triple Oral Therapy In The Treatment Of Type 2 Diabetes After Failure Of Two Oral Drugs

Insulin 70/30 Mix Plus Metformin Versus Triple Oral Therapy In The Treatment Of Type 2 Diabetes After Failure Of Two Oral Drugs

Efficacy, safety, and cost analysis Abstract OBJECTIVE—Subjects (n = 188) with type 2 diabetes and inadequate response to two oral medications (A1C >8.0%) were randomly assigned to treatment with either a third oral medication or an insulin 70/30 mix b.i.d. plus metformin for a comparison of efficacy, safety, and cost. RESEARCH DESIGN AND METHODS—The protocol called for aggressive dose titration to achieve target values of fasting blood glucose (80–120 mg/dl), postprandial glucose (<160 mg/dl), and A1C (<7%). These efficacy parameters were evaluated at weeks 2, 6, 12, and 24 of therapy. If dose adjustments failed to achieve targeted glycemic control, subjects were switched to an alternate therapy. RESULTS—At the end of study (week 24 of therapy), A1C and fasting plasma glucose (FPG) values showed comparable decreases in the two treatment groups. Only 31% (oral therapy) and 32% (insulin plus metformin) of subjects achieved target values of A1C (<7%). A total of 10 of the 98 subjects randomized to triple oral therapy (10.2%) who failed to improve sufficiently were switched to insulin therapy. An additional four subjects dropped out of the oral treatment group due to adverse events felt to be potentially drug related. Only two of the subjects randomized to insulin plus metformin had to be switched to basal-bolus regimens (regular insulin and NPH insulin). Cost analysis determined that insulin plus metformin (mean cost $3.20/day) provided efficacy equal to that of a triple oral drug regimen ($10.40/day). CONCLUSIONS—Insulin 70/30 mix plus metformin was as effective as triple oral therapy in lowering A1C and FPG values. The triple oral regimen was not as cost effective, and a high percentage of subjects (total of 16.3%) did not complete this regimen due to lack of Continue reading >>

Metformin: Improving Insulin Sensitivity

Metformin: Improving Insulin Sensitivity

Metformin is the only medication in the biguanides category of blood glucose-lowering drugs approved by the U.S. Food and Drug Administration (FDA). Metformin has been available in the United States since the mid-1990s, when it received FDA approval. You may also know it by its brand name when it was under patent, Glucophage. Metformin is now widely available as a relatively inexpensive generic medication. Metformin’s main action is to decrease the overproduction of glucose by the liver, a common problem in prediabetes and type 2 diabetes. The action of metformin helps lower blood sugar levels particularly during the night to keep fasting glucose levels under control, but it also helps control blood glucose throughout the day. Metformin also increases the uptake of glucose by your muscles. Overall, metformin decreases insulin resistance and improves insulin sensitivity, thereby helping the insulin your body still makes work more effectively. People with prediabetes and in the early years of type 2 diabetes often continue to make some insulin, just not enough to control blood sugar levels alone. Metformin is not formally approved for use in prediabetes, and any use to treat prediabetes is considered off-label by providers. Since its approval, metformin has become the most commonly recommended blood glucose-lowering medication to treat type 2 diabetes. In recent years it has significantly replaced sulfonylureas, such as glipizide and glyburide. Today both the American Diabetes Association (ADA), the European Association for the Study of Diabetes (EASD), and the American Association of Clinical Endocrinologists (AACE) generally recommend that people with type 2 diabetes start taking metformin when they are diagnosed to help treat insulin resistance and maximize insulin s Continue reading >>

Insulin-metformin Combo Tied To Poorer Survival

Insulin-metformin Combo Tied To Poorer Survival

HealthDay Reporter TUESDAY, June 10, 2014 (HealthDay News) -- The combination of metformin and insulin for people with type 2 diabetes may slightly increase death rates among patients, according to researchers from Vanderbilt University. However, other experts question the study's conclusions and claim it is at odds with other better-designed studies that show the combination of metformin and insulin is both safe and effective. "Insulin remains a reasonable option for patients who have very high glucose [blood sugar] or who desire flexible and fast blood sugar control, but most patients taking metformin prefer to delay starting insulin," said lead researcher Dr. Christianne Roumie, an associate professor of internal medicine and pediatrics at Vanderbilt University in Nashville, Tenn. "The current study suggests that adding a sulfonylurea to metformin should be preferred to adding insulin for most patients who need a second diabetes drug," she said. Sulfonylureas include glibenclamide (Micronase), glimepiride (Amaryl), glipizide (Glucotrol) and others. They work by stimulating the body to make more insulin. Roumie's team found that, compared with those who added a sulfonylurea, those who added insulin to metformin had 30 percent higher odds of heart attack, stroke and death from any cause during the study period. "Although new heart attacks and strokes occurred at similar rates in both groups, mortality was higher in patients who added insulin," she said. Roumie said she doesn't know why the rate of deaths was higher among study patients taking insulin. "We have a number of studies planned to examine possible mechanisms. We are investigating type 2 diabetes outcomes associated with blood sugar swings and with episodes of hypoglycemia (low blood sugar) tied to insulin," s Continue reading >>

Comparison Of Metformin And Insulin Versus Insulin Alone For Type 2 Diabetes: Systematic Review Of Randomised Clinical Trials With Meta-analyses And Trial Sequential Analyses

Comparison Of Metformin And Insulin Versus Insulin Alone For Type 2 Diabetes: Systematic Review Of Randomised Clinical Trials With Meta-analyses And Trial Sequential Analyses

Abstract Objectives To compare the benefits and harms of metformin and insulin versus insulin alone as reported in randomised clinical trials of patients with type 2 diabetes. Design Systematic review of randomised clinical trials with meta-analyses and trial sequential analyses. Data sources The Cochrane Library, Medline, Embase, Science Citation Index Expanded, Latin American Caribbean Health Sciences Literature, and Cumulative Index to Nursing and Allied Health Literature until March 2011. We also searched abstracts presented at the American Diabetes Association and European Association for the Study of Diabetes Congresses, contacted relevant trial authors and pharmaceutical companies, hand searched reference lists of included trials, and searched the US Food and Drug Administration website. Review methods Two authors independently screened titles and abstracts for randomised clinical trials comparing metformin and insulin versus insulin alone (with or without placebo) in patients with type 2 diabetes, older than 18 years, and with an intervention period of at least 12 weeks. We included trials irrespective of language, publication status, predefined outcomes, antidiabetic interventions used before randomisation, and reported outcomes. Results We included 26 randomised trials with 2286 participants, of which 23 trials with 2117 participants could provide data. All trials had high risk of bias. Data were sparse for outcomes relevant to patients. Metformin and insulin versus insulin alone did not significantly affect all cause mortality (relative risk 1.30, 95% confidence interval 0.57 to 2.99) or cardiovascular mortality (1.70, 0.35 to 8.30). Trial sequential analyses showed that more trials were needed before reliable conclusions could be drawn regarding these outcom Continue reading >>

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