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Acarbose vs. bedtime NPH insulin in the treatment of secondary failures to sulphonylurea‐metformin therapy in type 2 diabetes mellitus
Author(s) -
LópezAlvarenga J. C.,
AguilarSalinas C. A.,
VelascoPerez M. L.,
AritaMelzer O.,
Guillen L. E.,
Wong B.,
Brito G.,
Mercado V.,
GómezPérez F. J.,
RullRodrigo J. A.
Publication year - 1999
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1046/j.1463-1326.1999.00007.x
Subject(s) - acarbose , postprandial , medicine , endocrinology , bedtime , metformin , insulin , crossover study , type 2 diabetes , diabetes mellitus , placebo , type 2 diabetes mellitus , alternative medicine , pathology
Summary Objective : To evaluate the efficacy of acarbose in the treatment of secondary failures to sulphonylurea‐metformin therapy, its comparison against bedtime NPH insulin, and to measure the changes in postprandial metabolism resulting from both treatments. Methods : One hundred type 2 diabetic patients in a secondary failure were included. The study begun with a run‐in diet period of 6 weeks, in which an isocaloric diet was prescribed. Only subjects who continued hyperglycaemic were randomly assigned to placebo and acarbose (n = 17) or bedtime NPH insulin (n = 12). Acarbose (300 mg/day) or placebo were administered using a randomized, double blind, crossover design. Treatment periods of 3 months were separated by a 3‐week washout period. Insulin was administered during 3 months. At the beginning and the end of each treatment period, an i.v. glucose tolerance test and a meal test were performed. Safety tests were done every 4 weeks. Results : Acarbose resulted in a small but significant improvement in fasting plasma glucose (13.5 ± 2.4 vs. 11.3 ± 3.9 mmol/l, p = 0.05), HbA1 c (11.1 ± 3.4 vs. 10.3 ± 2.5%, P = 0.3) and in a decreased plasma glucose during the meal test. Bedtime insulin significantly decreased fasting plasma glucose (13.1 ± 2.9 vs. 8.2 ± 2.3 mmol/l, p < 0.01), HbA1c (11.7 ± 2.9 vs. 9.4 ± 2.7%, p < 0.01) and plasma cholesterol. No change in insulin secretion resulted from insulin and acarbose treatment. Conclusions : Acarbose decreases blood glucose in secondary failure to sulphonylurea‐metformin therapy; however, the decrease is not enough to reach the desired metabolic control. Bedtime NPH insulin is, by far, a more effective alternative.