Effectiveness of Insulin Versus Oral Agents in Patients with Uncontrolled Type 2 Diabetes Mellitus: A Retrospective Comparative Study

Background Type 2 diabetes mellitus (T2DM) is a chronic, progressive metabolic disorder characterized by insulin resistance and declining beta-cell function, resulting in elevated blood glucose levels. Its multifactorial pathogenesis involves complex interactions between genetic predisposition and environmental factors such as obesity, sedentary lifestyle, and diet. While lifestyle modifications remain the cornerstone of management, pharmacological intervention is often required to achieve and maintain optimal glycemic control. Objective This study aimed to evaluate the effectiveness of insulin therapy versus oral hypoglycemic agents in controlling blood glucose, along with assessing the safety profiles and patient adherence to both treatment modalities. Methods This retrospective study was conducted at Services Hospital, Lahore, Pakistan, from December 2023 to December 2024. A total of 255 patients diagnosed with uncontrolled T2DM were included in the study. Data were collected through medical records by using a structured proforma, which included demographic details (age, gender, BMI), medical history (duration of diabetes, comorbidities), current medication regimen (insulin or oral agents), and laboratory measurements (HbA1c, fasting blood glucose). Other clinical parameters, such as blood pressure, weight, and presence of complications (e.g., neuropathy, retinopathy), were also recorded. Results Insulin therapy resulted in a greater reduction in HbA1c (mean change -1.3%) and fasting blood glucose (mean change -38.2 mg/dL) compared to oral agents (mean change in HbA1c -0.6%, mean change in fasting blood glucose -25.6 mg/dL), with both groups showing statistically significant improvements (p < 0.001). However, insulin therapy was associated with a higher incidence of hypoglycemia (18% vs. 7%, p = 0.02) and weight gain (mean increase 2.3 ± 1.4 kg vs. 0.9 ± 0.8 kg, p < 0.001). Oral agents were linked to more gastrointestinal side effects (15% vs. 5%, p = 0.01). Patient adherence was similar between the two groups, with no significant difference (90% in the oral agents group vs. 85% in the insulin therapy group). Conclusion Insulin therapy offers superior glycemic control compared to oral agents but carries a higher risk of hypoglycemia and weight gain. Oral agents, while less effective, have a safer side effect profile and are preferred in patients at risk of hypoglycemia or those concerned about weight gain. Treatment choice should be individualized, considering patient preferences, comorbidities, and the risks and benefits of each therapy.