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A Randomized Crossover Study of Sulphonylurea and Insulin Treatment in Patients with Type 2 Diabetes Poorly Controlled on Dietary Therapy
Author(s) -
Wolffenbuttel B.H.R.,
Weber R.F.A.,
Koetsveld P.M.,
Weeks L.,
Verschoor L.
Publication year - 1989
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.1989.tb01220.x
Subject(s) - medicine , postprandial , insulin , endocrinology , crossover study , diabetes mellitus , glibenclamide , type 2 diabetes , placebo , alternative medicine , pathology
In 13 non‐obese patients with Type 2 diabetes mellitus who failed to achieve adequate blood glucose control on dietary treatment (fasting blood glucose 13.4 ± 2.7 (±SD) mmol I −1 , glycosylated haemoglobin 13.0 ± 1.7 %), the effects of 6 months insulin or sulphonylurea therapy on blood glucose control and lipid metabolism were compared in a randomized crossover study. Three patients, who showed a clear improvement on insulin (median glycosylated haemoglobin fell from 14.7 to 8.6 %), withdrew from the study prematurely because of subjective and objective signs of hyperglycaemia after crossover from insulin to sulphonylurea. Daily dose after 6 months was 2000 mg tolbutamide ( n =3), 18 ± 1 mg glibenclamide ( n =7), or 34 ± 3 U insulin. On insulin, fasting (8.0 ± 1.9 mmol I −1 ) and postprandial blood glucose (10.4 ± 2.7 mmol I −1 ), and glycosylated haemoglobin (9.5 ± 1.1 %) were lower than on sulphonylurea (11.0 ± 3.4 mmol I −1 , 14.4 ± 4.8 mmol I −1 and 11.0 ± 2.5 %, respectively, p < 0.05 in each case). Median increase in body weight was greater on insulin (4.2 vs 1.1 kg, p < 0.05). Six patients experienced improved well‐being on insulin compared with sulphonylurea. Median plasma non‐esterified fatty acids decreased from 825 μmol I −1 to 476 μmol I −1 (sulphonylurea) and 642 μmol I −1 (insulin, both p < 0.05). HDL cholesterol was higher after insulin (1.12 ± 0.40 mmol I −1 ) than after sulphonylurea (0.94 ± 0.25 mmol I −1 , p < 0.05), and the LDL:HDL cholesterol ratio (3.27 ± 1.07 vs 3.90 ± 1.08) and VLDL triglycerides (0.67 ± 0.22 vs 1.13 ± 0.40 mmol I −1 ) were lower (both p < 0.05). A C‐peptide response after intravenous glucagon of below 5.0 nmol I −1 15 min identified those patients who had better blood glucose control with insulin.