(HealthDay News) — Adding a sulfonylurea or metformin to insulin is associated with approximately a 1% reduction in hemoglobin A1c (HbA1c), and addition of a sulfonylurea (but not metformin) is associated with more hypoglycemic events, according a clinical evidence synopsis published online in the Journal of the American Medical Association.

Rimke C. Vos, PhD, and Guy EHM Rutten, MD, PhD, from University Medical Center Utrecht in the Netherlands, summarized a research review of studies that examined the effect of the addition of oral hypoglycemic agents among patients with type 2 diabetes who do not achieve optimal glycemic control with insulin monotherapy.

The researchers found that adding a sulfonylurea to insulin was correlated with more hypoglycemic events than insulin alone; this was not seen for metformin. There was an approximate 1% decrease in HbA1c with the addition of a sulfonylurea or metformin to insulin.

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“Future randomized clinical trials could address the effect of adding oral hypoglycemic agents to insulin therapy for the outcomes of diabetes-related morbidity and mortality, all-cause mortality, and quality of life,” the authors write.

The authors disclosed ties to the pharmaceutical industry.

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Vos RC and Rutten GEHM. Oral Hypoglycemic Agents Added to Insulin Monotherapy for Type 2 Diabetes. JAMA. 2017;318(15):1489-1490. doi:10.1001/jama.2017.13463