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Effectiveness and safety of glucose-lowering drugs as an adjunct to insulin therapy in Chinese patients with type 1 diabetes: a retrospective, observational study

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Abstract

Aim

To assess the real-world impact of glucose-lowering drugs (GLDs) as an adjunct to insulin in Chinese patients with type 1 diabetes (T1DM).

Methods

This dual-center, observational, retrospective study included 121 T1DM patients receiving GLDs as adjuncts and 56 participants with insulin-only drugs as comparators. Glycated hemoglobin A1c (HbA1c), daily insulin dosage, fasting blood glucose (FBG), postprandial blood glucose (PBG), nocturnal blood glucose (NBG) and the difference in trough and peak blood glucose levels on the same day (Δ TP) were assessed at baseline and at the end of the study.

Results

In total, HbA1c decreased by 1.14% in the GLD+insulin group (p < 0.0001) and 0.36% in the insulin-only group (p = 0.0423, mean adjusted difference, −0.09% [95% CI, −0.55 to 0.37]). The total daily insulin concentration was reduced by 7.34 U per day in the GLD+insulin group vs. 5.55 U per day in the insulin-only group (mean adjusted difference, −2.32 U [95% CI, −4.97 to 0.33]). In particular, among patients with fasting C-peptide levels < 17 pmol/L, the total daily insulin concentration was significantly reduced by 9.22 U vs. 5.09 U per day (mean adjusted difference, −3.84 [95% CI, −6.85-0.84]; p = 0.0129). There were no notable differences in the other glycemic indices between the two groups. A gradual downward trend in changes in glycemic outcomes was observed among patients treated with various combinations of metformin, acarbose, and dipeptidyl peptidase 4 inhibitor (DPP-4i). Similar reductions in the daily insulin dose were also detected in most of the GLD+insulin group in addition to the DPP-4i-only group. No severe hypoglycemia was induced by additional GLDs.

Conclusions

The use of additional GLDs tends to improve glycemic outcomes and reduce insulin requirements in patients with T1DM. These results indicate that the use of GLDs as an adjunctive therapy may have been an effective treatment strategy among adults with T1DM in China.

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Data availability

The raw data supporting the conclusions of this article will be made available by the authors. Further inquiries can be directed to the corresponding author.

Abbreviations

T1DM:

Type 1 diabetes

GLD:

glucose-lowering drugs

DPP-4i:

Dipeptidyl peptidase 4 inhibitor

IR:

Insulin resistance

HbA1c:

Glycated hemoglobin A1c

RCTs:

Randomized controlled trials

FBG:

Fasting blood glucose

PBG:

Postprandial blood glucose

NBG:

Nocturnal blood glucose

Δ TP:

Difference of trough and peak blood glucose level in the same day

FCP:

Fasting plasma C-peptide levels

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Author notes

  1. These authors contributed equally: Chenyang Shi, Shanshan Hu, Yi Lin

Authors and Affiliations

  1. Department of Clinical Pharmacy, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Chenyang shi, Shanshan Hu, Yuanjun Tang & Guorong Fan

  2. Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Yi Lin

  3. Department of Military Health Statistics, Naval Medical University, Shanghai, China

    Yingyi Qin

  4. Department of Endocrinology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China

    Zhaosheng Tang

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Contributions

Zhaosheng Tang and Guorong Fan were involved in study design. Chenyang Shi was involved in study design, interpretation of data, and editorial support. Yi Lin and Yingyi Qin contributed to study design, data collection, and data analysis. ShanShan Hu and contributed to data analysis, interpretation and editorial support. Yuanjun Tang was involved in data collection. All authors read the final version of the manuscript critically and approved the submitted version.

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Correspondence to Yuanjun Tang, Guorong Fan or Zhaosheng Tang.

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The studies involving human participants were reviewed and approved by the Institutional Research Ethics Committee of Shanghai General Hospital (No: 2020KY225).

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shi, C., Hu, S., Lin, Y. et al. Effectiveness and safety of glucose-lowering drugs as an adjunct to insulin therapy in Chinese patients with type 1 diabetes: a retrospective, observational study. Endocrine (2024). https://doi.org/10.1007/s12020-024-04017-6

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