{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T21:04:29Z","timestamp":1740171869818,"version":"3.37.3"},"reference-count":33,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:p>Basal insulin treatment for type 2 diabetes is usually initiated on a background of oral glucose-lowering medications (OGLM). We wanted to examine the influence of various OGLMs on fasting plasma glucose (FPG) and hemoglobin A<jats:sub>1c<\/jats:sub>(HbA<jats:sub>1c<\/jats:sub>) values achieved after titration. A PubMed literature search retrieved 42 publications (clinical trials introducing basal insulin in 17\u2009433 insulin-na\u00efve patients with type 2 diabetes on a defined background of OGLM) and reporting FPG, HbA<jats:sub>1c<\/jats:sub>, target achievement, hypoglycemic events, and insulin doses. 60 individual study arms were grouped by OGLM (combinations) allowed during the titration process: (a) metformin only; (b) sulfonylureas only; (c) metformin and sulfonylureas; or (d) metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors. For all OGLM categories, weighted means and SD were calculated for baseline and end-of-treatment FPG, HbA<jats:sub>1c<\/jats:sub>, target achievement, incidence of hypoglycemic events, and insulin doses. Primary end point was a difference in FPG after titration between OGLM categories. Statistics: analysis of variance and post hoc comparisons. Sulfonylureas, alone or in combination with metformin, impair the titration of basal insulin (insulin doses 30%\u201340%\u2009lower, more hypoglycemic episodes), thus leading to poorer final glycemic control (p&lt;0.05 for FPG and HbA<jats:sub>1c<\/jats:sub>after titration). Conversely, adding a DPP-4 inhibitor to metformin is superior to metformin alone (p&lt;0.05 for FPG and HbA<jats:sub>1c<\/jats:sub>achieved) in patients with type 2 diabetes initiating basal insulin therapy. In conclusion, OGLM are a major determinant of the success of basal insulin therapy. Sulfonylureas impair, while DPP-4 inhibitors (added to metformin) may facilitate the achievement of ambitious fasting glucose targets. 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