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Adjunctive inhaled insulin before meals improved glycaemic control more than adjunctive metformin in type 2 diabetes mellitus

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 Q In patients with type 2 diabetes mellitus poorly controlled with sulphonylurea monotherapy, is adjunctive inhaled human insulin (INH) better than adjunctive metformin?

Clinical impact ratings GP/FP/Primary care ★★★★★★★ IM/Ambulatory care ★★★★★☆☆ Endocrine ★★★★★★


Embedded ImageDesign:

randomised controlled trial.

Embedded ImageAllocation:


Embedded ImageBlinding:


Embedded ImageFollow up period:

24 weeks.

Embedded ImageSetting:

13 centres in Europe, South Africa, Israel, and Brazil.

Embedded ImagePatients:

427 patients 35–80 years of age (mean age 60 y, 53% men) who had type 2 diabetes mellitus ⩾6 months, were poorly controlled on sulphonylurea therapy ⩾2 months, and had normal pulmonary function test results. Exclusion criteria included asthma or chronic obstructive pulmonary disease; smoking in the previous 6 months; concomitant therapy with hypoglycaemic agents or agents that may affect glycaemic control; fasting C …

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  • * See glossary.

  • For correspondence: Dr A H Barnett, Birmingham Heartlands Hospital, Birmingham, UK. anthony.barnett{at}

  • Source of funding: Pfizer.

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