Abstract

To compare the glycemic control of triple oral therapy with sulfonylurea, metformin and acarbose with insulin in type 2 diabetes mellitus patients. This was a prospective observational study, carried out in Sardjito Hospital in Yogyakarta Indonesia, from May 2007 - September 2008. The target population in patients diagnosed with type 2 diabetes who failed with oral antidiabetic medications. At baseline and at 3 -month intervals, level of HbA_1C, fasting plasma glucose (FPG), postprandial plasma glucose (PPG), hypoglycemic episodes, and adverse events were evaluated. Test for differences between the two groups were performed by Chi-Square test for categorical variables and by independent-samples t-test for continuous variables. Paired t-test was performed for pre-post measurements. All tests were performed using a two-tailed test at a significance level of 0.05. One hundred and fifteen patients (58 men and 57 women), aged 62.35 ± 8.88, and diabetes duration of 12.53 ± 6.97 years were studied. Over the 6 -month treatment period, HbA_1c levels decreased from 8.85 ± 2.02 to 8.33 ± 1.94% with insulin group (P = 0.011) and increased from 8.08 ± 1.89 to 8.73 ± 2.37% with triple oral therapy (P = 0.041). FPG and PPG levels decreased from 169.42 - 138.44 mg/dl (P = 0.002) and 238.26 - 197.97 mg/dl (P = 0.001) with insulin and increased from 160.39 - 170.71 mg/dl (P = 0.183) and 210.31 - 218.67 mg/dl (P = 0.458) with triple oral therapy, respectively. Addition of insulin in poorly controlled type 2 diabetic patients on metformin/sulfonylurea achieved a significantly greater reduction in HbA_1c, fasting plasma glucose, and postprandial plasma glucose versus those treated with sulfonylurea, metformin, and acarbose.

Key words: Insulin, triple oral therapy, glycemic effect, type 2 diabetes mellitus, Indonesia.