Microvascular and neuropathic
complications of diabetes mellitus can be significantly decreased by long-term, near-normoglycemic regulation in patients with
insulin-dependent diabetes mellitus. Prevention or delay of onset of
hyperglycemia in
non-insulin-dependent diabetes mellitus (
NIDDM) patients should reduce morbidity and mortality from these complications.
NIDDM can be nearly normoglycemic when diagnosed by screening before its symptomatic stage or when clinically hyperglycemic
NIDDM goes into remission. One potential strategy to delay the onset of
hyperglycemia in individuals at high risk is chronic low-dose sulfonylurea
therapy. Thirty black
NIDDM subjects who recently had developed near-normoglycemia were followed with no treatment or were randomly assigned to a 3-year, double-blind
glipizide or placebo treatment. Baseline and follow-up parameters included fasting plasma
glucose (FPG), HbA1c, plasma
insulin, and
glucose responses to an oral
glucose tolerance test and
insulin action, as determined by the euglycemic
insulin clamp. Baseline FPG and HbA1c for all three groups were 107 mg/dl and 4.7%, respectively. Relapse to
hyperglycemia was defined as an FPG level > or = 140 mg/dl on several consecutive visits or an FPG level > or = 140 mg/dl and symptoms of
hyperglycemia. During the course of the treatment and follow-up,
hyperglycemia occurred in 6 of 10 subjects in the no treatment group, 6 of 10 in the placebo group, and 2 of 10 in the
glipizide treatment group. Prolongation of near-normoglycemia was significantly (P < 0.05) increased by low-dose (2.5 mg/day)
glipizide compared with placebo treatment.(ABSTRACT TRUNCATED AT 250 WORDS)