Prevention of weight gain in type 2 diabetes requiring insulin treatment.

Abstract

BACKGROUND:

Patients with type 2 diabetes who are failing on oral agents will generally gain a large amount of body fat when switched to insulin treatment. This adverse effect may be related to chronic hyperinsulinism induced by long-acting insulin compounds.

AIM:

To test the concept that regain of glycaemic control can be achieved without causing weight gain, using a regimen free of long-acting insulin.

METHODS:

In a 3-month open-label pilot study including 25 patients with moderate overweight and secondary failure, we investigated whether nocturnal glycaemic control could be achieved with glimepiride administered at 20:00 hours. The starting dose was 1-2 mg, with subsequent titration up to a maximum of 6 mg. Rapid-acting insulin analogues were used three times daily to regain postprandial glucose control.

RESULTS:

Glycaemic control at 3 months was established with glimepiride in a dose of 4.4 +/- 0.3 mg/day (mean +/- standard error of the mean), and a total daily insulin dose of 24.1 +/- 2.6 IU. Fasting glucose levels decreased from 12.7 +/- 0.6 mmol/l to 8.1 +/- 0.3 mmol/l (p < 0.001), and target levels were reached in 14 of 25 patients (56%). Mean HbA1c decreased from 10.5 +/- 0.4 to 7.7 +/- 0.2% (p < 0.001). Symptomatic nocturnal hypoglycaemia was not reported. Body weight did not change (85.7 +/- 3.6 kg vs. 85.7 +/- 3.3 kg, p = 0.99).

CONCLUSION:

The data suggest that this new approach may be useful in about 50% of type 2 diabetes patients presenting with failure on maximal oral treatment.

• Authors: H de Boer, M Jansen, J Koerts, L Verschoor
• Journal: Diabetes, obesity & metabolism (Diabetes Obes Metab) Vol. 6 Issue 2 Pg. 114-9 (Mar 2004) ISSN: 1462-8902 [Print] England
• PMID: 14746576 (Publication Type: Journal Article)

Chemical References

• Blood Glucose
• C-Peptide
• Hypoglycemic Agents
• Insulin
• Sulfonylurea Compounds
• glimepiride
• Metformin

Topics

• Blood Glucose (analysis)
• C-Peptide (blood)
• Diabetes Mellitus, Type 2 (blood, drug therapy)
• Drug Administration Schedule
• Drug Therapy, Combination
• Female
• Humans
• Hypoglycemic Agents (therapeutic use)
• Insulin (therapeutic use)
• Male
• Metformin (therapeutic use)
• Middle Aged
• Pilot Projects
• Sulfonylurea Compounds (therapeutic use)
• Weight Gain