Skip to content

Diabetes Health Center

Insulin-Metformin Combo Tied to Poorer Survival

Other experts dispute the study's conclusions
Font Size
A
A
A

continued...

Focusing on about 2,400 patients who added insulin to metformin and just over 12,000 patients who added a sulfonylurea, Roumie's group found that during an average of 14 months of follow-up, the rate of heart attacks and strokes was similar in both groups. However, the rate of death from any cause was higher among those patients taking insulin, the investigators reported.

Other experts dispute the study's conclusions.

Dr. Robert Ratner, chief scientific and medical officer at the American Diabetes Association, said, "I disagree with metformin and insulin being a bad combination."

Ratner said that there are other factors that could explain the results of this study. Those placed on insulin had higher blood sugar levels and had other serious medical conditions, he said.

"These were not equivalent populations. If you're sicker, then it's not surprising you're going to have worse outcomes," Ratner said.

Ratner noted that a randomized trial that compared these same drug combinations, called the ORIGIN trial (Outcome Reduction With Initial Glargine Intervention), which followed some 12,000 patients over seven years, came to a different conclusion.

"What they found in ORIGIN was there was no difference in heart attacks or strokes between the two groups, there was no difference in cancer, and there was no difference in all-cause deaths," he explained. "So the better study showed no difference."

Ratner said, based on this current study, there is no reason to change treatment.

Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, agreed. "You cannot make any conclusions from this study," he said.

"We are using much newer medications," Zonszein said. "In the VA, they don't use those new medications. They use medications from the last century. The VA continues to use inexpensive therapy that is not very effective."

Zonszein said that new drugs such as Victoza or Januvia are very expensive and often are not covered by insurance, or if they are, they have very high co-pays.

Ratner added, "We really don't know what the best drug is to add after metformin." The American Diabetes Association recommends an individualized patient approach that takes into account the patient's condition as well as the cost of treatment, he said.

A new trial is getting underway that might better pinpoint the most effective and safe treatment, Ratner said. The new study will compare adding insulin or a sulfonylurea or newer drugs like Victoza or Januvia to metformin. "Hopefully, we will have a much better answer in the next several years," Ratner added.

1 | 2

Is This Normal? Get the Facts Fast!

Check Your Blood Sugar Level Now
What type of diabetes do you have?
Your gender:

Get the latest Diabetes newsletter delivered to your inbox!


or
Answer:
Low
0-69
Normal
70-130
High
131+

Your level is currently

If the level is below 70 or you are experiencing symptoms such as shaking, sweating or difficulty thinking, you will need to raise the number immediately. A quick solution is to eat a few pieces of hard candy or 1 tablespoon of sugar or honey. Recheck your numbers again in 15 minutes to see if the number has gone up. If not, repeat the steps above or call your doctor.

People who experience hypoglycemia several times in a week should call their health care provider. It's important to monitor your levels each day so you can make sure your numbers are within the range. If you are pregnant always consult with your health care provider.

Congratulations on taking steps to manage your health.

However, it's important to continue to track your numbers so that you can make lifestyle changes if needed. If you are pregnant always consult with your physician.

Your level is high if this reading was taken before eating. Aim for 70-130 before meals and less than 180 two hours after meals.

Even if your number is high, it's not too late for you to take control of your health and lower your blood sugar.

One of the first steps is to monitor your levels each day. If you are pregnant always consult with your physician.

Did You Know Your Lifestyle Choices
Affect Your Blood Sugar?

Use the Blood Glucose Tracker to monitor
how well you manage your blood sugar over time.

Get Started

This tool is not intended for women who are pregnant.

Start Over

Step:  of 

Today on WebMD

Diabetic tools
Symptoms, diagnosis, treatment, and more.
woman flexing muscles
10 strength training exercises.
 
Blood sugar test
12 practical tips.
Tom Hanks
Stars living with type 1 or type 2.
 
Woman serving fast food from window
Video
Can Vinegar Treat Diabetes
Video
 
Middle aged person
Tool
are battery operated toothbrushes really better
Video
 

Prediabetes How to Prevent Type 2 Diabetes
Article
type 2 diabetes
Slideshow
 
food fitness planner
Tool
Are You at Risk for Dupuytrens Contracture
Article