Clinical Experience with Quintuple Non-Insulin Drug Therapy in Suboptimally Controlled Type 2 Diabetes

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INTRODUCTION: Current evidence for individuals experiencing Type 2 Diabetes (T2D), who refuse insulin treatment and are given five non-insulin antidiabetic drug combinations, is scarce. METHODS: We conducted a retrospective observational study to investigate the prevalence of quintuple non-insulin drug regimens during a 12-month period, in patients with suboptimally controlled T2D who refuse insulin therapy. RESULTS: 1463 individuals with T2D were assessed during the course of the investigation. Forty patients (2.7%) satisfied the eligibility criteria and were included. The mean therapeutic period was 35.5 ± 29.2 months, and the mean A1C was 7.5± 1.0%. The majority of patients received pioglitazone as the fifth choice to background quadruple regimens (70%). The mean decrease in A1C levels was 0.82 ± 0.99% compared to baseline indices without notable side effects and safety concerns (p < 0.001). Fear of starting insulin was the major reason for rejecting insulin therapy. DISCUSSION: Despite the limitations inherent to its retrospective design, this study shows that five non-insulin drug combinations can be considered a possible therapeutic option for this difficultto-treat group of patients, at least until they are convinced to start and maintain insulin therapy. CONCLUSION: The prevalence of individuals with T2D treated with quintuple non-insulin drug regimens was 2.7% without any notable side effects or safety concerns. In patients who refuse insulin therapy, these combinations can be taken into consideration according to the characteristics of every individual and carefully evaluated for their safety and effectiveness.

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