NICE have previously issued guidance regarding the use of oral agent combination therapy with insulin (1):
combining basal insulin therapy and oral agent (s)
when starting basal insulin therapy:
continue with metformin and the sulfonylurea (and acarbose, if used)
review the use of the sulfonylurea if hypoglycaemia occurs
combining pre-mixed insulin and oral agent (s)
when starting pre-mixed insulin therapy (or mealtime plus basal insulin regimens):
continue with metformin
continue the sulfonylurea initially, but review and discontinue if hypoglycaemia occurs
combining insulin and pioglitazone
consider combining pioglitazone with insulin therapy for:
a person who has previously had a marked glucose-lowering response to thiazolidinedione therapy
a person on high-dose insulin therapy whose blood glucose is inadequately controlled. Warn the person to discontinue pioglitazone if clinically significant fluid retention develops
Updated guidance contains minimal guidance with respect to oral agents and insulin (2):
for adults with type 2 diabetes starting insulin therapy, continue to offer metformin for people without contraindications or intolerance. Review the continued need for other blood glucose lowering therapies
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