title: A randomized crossover study of sulphonylurea and insulin treatment in patients with type 2 diabetes poorly controlled on dietary therapy.
abstract: 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 l-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 l-1) and postprandial blood glucose (10.4 +/- 2.7 mmol l-1), and glycosylated haemoglobin (9.5 +/- 1.1%) were lower than on sulphonylurea (11.0 +/- 3.4 mmol l-1, 14.4 +/- 4.8 mmol l-1 and 11.0 +/- 2.5%, respectively, p less than 0.05 in each case). Median increase in body weight was greater on insulin (4.2 vs 1.1 kg, p less than 0.05). Six patients experienced improved well-being on insulin compared with sulphonylurea. Median plasma non-esterified fatty acids decreased from 825 mumol l-1 to 476 mumol l-1 (sulphonylurea) and 642 mumol l-1 (insulin, both p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Internal Medicine III and Clinical Endocrinology, University Hospital Rotterdam, Dijkzigt, The Netherlands.
authors.forename: B H
authors.initials: BH
authors.lastname: Wolffenbuttel
authors.forename: R F
authors.initials: RF
authors.lastname: Weber
authors.forename: P M
authors.initials: PM
authors.lastname: van Koetsveld
authors.forename: L
authors.initials: L
authors.lastname: Weeks
authors.forename: L
authors.initials: L
authors.lastname: Verschoor
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D003927:Diet, Diabetic; D005215:Fasting; D005260:Female; D005905:Glyburide / Q000627:therapeutic use*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D007515:Islets of Langerhans / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D014044:Tolbutamide / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D005905:Glyburide; D006442:Glycated Hemoglobin; D007328:Insulin; D014044:Tolbutamide