NICE guidance - insulin therapy in combination with oral hypoglycaemic agent (s) in type 2 diabetes
Last edited 02/2022 and last reviewed 02/2022
- NICE have previously issued guidance regarding the use of oral agent combination therapy
with insulin (1):
- combining basal insulin therapy and oral agent (s)
- when
starting basal insulin therapy:
- continue with metformin and the sulfonylurea (and acarbose, if used)
- review the use of the sulfonylurea if hypoglycaemia occurs
- when
starting basal insulin therapy:
- combining pre-mixed insulin and oral agent
(s)
- when starting pre-mixed insulin therapy (or mealtime plus basal
insulin regimens):
- continue with metformin
- continue the sulfonylurea initially, but review and discontinue if hypoglycaemia occurs
- when starting pre-mixed insulin therapy (or mealtime plus basal
insulin regimens):
- combining
insulin and pioglitazone
- consider combining pioglitazone with insulin
therapy for:
- a person who has previously had a marked glucose-lowering response to thiazolidinedione therapy
- a person on high-dose insulin therapy
whose blood glucose is inadequately controlled. Warn the person to discontinue
pioglitazone if clinically significant fluid retention develops
- consider combining pioglitazone with insulin
therapy for:
- combining basal insulin therapy and oral agent (s)
- Updated guidance contains minimal guidance with respect to oral agents and insulin (2):
- for adults with type 2 diabetes starting insulin therapy, continue to offer metformin for people without contraindications or intolerance. Review the continued need for other blood glucose lowering therapies
Reference: