Insulin has been used in combination with every other type of pharmacological therapy for glycemic control in T2DM. Combination therapy with a sulfonylurea has been extensively studied, with overall improved glycemic control in individuals on a bedtime dose of intermediate or long-acting insulin.79,80 The concurrent use of insulin and metformin can modestly decrease HbA1C values and may also decrease the amount of weight gain associated with insulin alone. Thiazolidinediones maintain or slightly lower HbA1C levels when used with insulin, and further decrease the required insulin dose, but may result in additional weight gain. A clinical study investigating the use of acarbose with insulin therapy showed a 0.5% decrease in HbA1C values, which is likely due to an improvement in postprandial hyperglycemia.
It remains unclear, however, if the benefits of combination therapy outweigh the added expense and only modest improvements in HbA1C. Combination therapy also has the potential for added toxicity, drug interactions, and decreased compliance.
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