Metformin and glimepiride with basal insulin lowered HbA1c the most

Evidence Suggest

• HbA1c fell by 1.41% with insulin glargine plus metformin and glimepiride, compared with 0.75% with glargine plus metformin and 0.70% with glargine plus glimepiride.
• Triple therapy lowered HbA1c significantly more than glargine plus metformin and more than glargine plus glimepiride.
• Seventy-five percent of the triple-therapy group reached HbA1c at or below 7.5%, compared with 43.8% in the glargine plus metformin group.
• Rates of symptomatic, nocturnal, and severe hypoglycemia did not differ significantly between treatment groups.

Who this applies to

These findings apply most directly to adults with type 2 diabetes who remain above target despite sulfonylurea plus metformin therapy and are about to start basal insulin. The study population was Korean, non-insulin-treated before enrollment, and relatively lean by usual type 2 diabetes trial standards.

Keep in Mind

This was a short, open-label study, so longer-term durability and safety are still uncertain. The results support the triple combination over 24 weeks, but treatment should still be individualized based on hypoglycemia risk, kidney and liver function, body weight, and how well a patient can manage insulin titration and glucose monitoring.

Between the Lines

• The trial was open-label.
• The sample size was modest at 99 randomized participants.
• Follow-up lasted only 24 weeks.
• The study population was limited to Korean adults with BMI below 30 kg/m2.