Evidence mapPaperPMID 33855207Full record

Trial reportEndocrinology, diabetes & metabolism2021

Is the stepping-down approach a better option than multiple daily injections in obese patients with poorly controlled Type 2 diabetes on advanced insulin therapy?

Soe Naing, Geeta Ramesh, Jasmine Garcha, Anupama Poliyedath, Stutee Khandelwal, Paul K Mills

Open access · goldAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Endocrinology, diabetes & metabolism, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
1.0field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 16 citations in OpenAlex.

  1. Trial
  2. Review
  3. Article
  4. Article
  5. Review
  6. Simplification of Complex Insulin Regimens with IdegLira in People with Type 2 Diabetes: Literature Review and Clinical Recommendations.Diabetes therapy : research, treatment and education of diabetes and related disorders · 2023
    Article
  7. Review
  8. [Injection therapy of diabetes].Wiener klinische Wochenschrift · 2023
    Article
  9. Review
  10. Insulin Withdrawal in Diabetic Kidney Disease: What Are We Waiting for?International journal of environmental research and public health · 2021
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 1 country.

Soe NaingDivision of Endocrinology, University of California San Francisco, Fresno Medical Education Program, Fresno, CA, USA.ORCID https://orcid.org/0000-0003-1863-0572
Geeta RameshDepartment of Family & Community Medicine, University of California San Francisco, Fresno Medical Education Program, Fresno, CA, USA.
Jasmine GarchaDepartment of Family & Community Medicine, University of California San Francisco, Fresno Medical Education Program, Fresno, CA, USA.
Anupama PoliyedathDepartment of Internal Medicine, St Agnes Internal Medicine Residency Program, Fresno, CA, USA.
Stutee KhandelwalDepartment of Internal Medicine, University of California San Francisco, Fresno Medical Education Program, Fresno, CA, USA.
Paul K MillsDepartment of Internal Medicine, University of California San Francisco, Fresno Medical Education Program, Fresno, CA, USA.
University of California, San Francisco · USSaint Agnes Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Aim: To determine whether de-escalating from advanced insulin therapy (AIT) to the combined use of metformin, an SGLT2 inhibitor, a GLP1 receptor agonist and basal insulin is the better option than multiple daily insulin injections (MDI) in obese patients with poorly controlled T2DM. Methods: This was a 16-week, prospective, randomized, controlled trial. Twenty-two obese patients with T2DM on AIT were randomized to intervention (step-down) or control (MDI) group. In the intervention group, all prandial insulin injections were discontinued, but the patient remained on basal insulin and metformin, to which an SGLT2i and a GLP1 RA were added. In the control group, the patient remained on MDI. Results: Compared to control group ( Conclusion: De-escalating from AIT to the combined use of metformin, SGLT2i, GLP1 RA and basal insulin in obese patients with poorly controlled T2DM on MDI resulted in significant improvement in glycaemic control, weight loss and significantly higher patient satisfaction. This stepping-down approach may be the better option than continuing MDI in these patients.

Indexed as

Glycemic ControlAdultAgedDiabetes Mellitus, Type 2Drug TaperingDrug Therapy, CombinationFemaleHumansHypoglycemic AgentsInjectionsInsulinMaleMetforminMiddle AgedObesityProspective StudiesHypoglycemic AgentsInsulinMetforminSodium-Glucose Transporter 2 InhibitorsGLP‐1 analogueglycaemic controlinsulin therapySGLT2 inhibitortype 2 diabetes

Identifiers

PMID33855207
PMCPMC8029542
OpenAlexW3115093344

What Socratic holds

Texttitle and abstract
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.