Beneficial effects of insulin versus sulphonylurea on insulin secretion and metabolic control in recently diagnosed type 2 diabetic patients.

Abstract

OBJECTIVE:

To evaluate whether treatment with insulin in recently diagnosed type 2 diabetes is advantageous compared with glibenclamide treatment.

RESEARCH DESIGN AND METHODS:

Beta-cell function, glycemic control, and quality of life were monitored over 2 years in 39 patients with islet cell antibody-negative type 2 diabetes diagnosed 0-2 years before inclusion in a Swedish multicenter randomized clinical trial. Patients were randomized to either two daily injections of premixed 30% soluble and 70% NPH insulin or glibenclamide (3.5-10.5 mg daily). C-peptide-glucagon tests were performed yearly in duplicate after 2-3 days of temporary withdrawal of treatment.

RESULTS:

After 1 year the glucagon-stimulated C-peptide response was increased in the insulin-treated group by 0.14 +/- 0.08 nmol/l, whereas it was decreased by 0.12 +/- 0.08 nmol/l in the glibenclamide group, P < 0.02 for difference between groups. After 2 years, fasting insulin levels were higher after treatment withdrawal in the insulin-treated versus the glibenclamide-treated group (P = 0.02). HbA(1c) levels decreased significantly during the first year in both groups; however, at the end of the second year, HbA(1c) had deteriorated in the glibenclamide group (P < 0.01), but not in the insulin-treated group. The difference in evolution of HbA(1c) during the second year was significant between groups, P < 0.02. A questionnaire indicated no difference in well-being related to treatment.

CONCLUSIONS:

Early insulin versus glibenclamide treatment in type 2 diabetes temporarily prolongs endogenous insulin secretion and promotes better metabolic control.

• Authors: Michael Alvarsson, Göran Sundkvist, Ibe Lager, Marianne Henricsson, Kerstin Berntorp, Eva Fernqvist-Forbes, Lars Steen, Gunilla Westermark, Per Westermark, Thomas Orn, Valdemar Grill
• Journal: Diabetes care (Diabetes Care) Vol. 26 Issue 8 Pg. 2231-7 (Aug 2003) ISSN: 0149-5992 [Print] United States
• PMID: 12882841 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Amyloid
• Blood Glucose
• C-Peptide
• Cholesterol, HDL
• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin
• Islet Amyloid Polypeptide
• Glucagon
• Proinsulin
• Glyburide

Topics

• Adult
• Aged
• Amyloid (blood)
• Blood Glucose
• Body Weight (drug effects)
• C-Peptide (blood)
• Cholesterol, HDL (blood)
• Diabetes Mellitus, Type 2 (drug therapy, metabolism)
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Glucagon (blood)
• Glyburide (administration & dosage, adverse effects)
• Glycated Hemoglobin (analysis)
• Humans
• Hypoglycemic Agents (administration & dosage, adverse effects, metabolism)
• Insulin (administration & dosage, adverse effects, metabolism)
• Insulin Secretion
• Islet Amyloid Polypeptide
• Islets of Langerhans (metabolism)
• Male
• Middle Aged
• Proinsulin (blood)
• Quality of Life