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NICE guidance - insulin therapy in combination with oral hypoglycaemic agent (s) in type 2 diabetes

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • 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
    • 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
    • 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

  • 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:

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