A long-term, randomized, comparative study of insulin versus sulfonylurea therapy in type 2 diabetes.
OBJECTIVE
To study the effect of insulin and sulfonylurea (SU) therapy on glycaemic control, insulin resistance and cardiovascular risk factors in type 2 diabetic subjects.


METHODS
A prospective, parallel, randomized, controlled, long-term study.


METHODS
Outpatient clinic in tertiary referral centre.


METHODS
Thirty-six type 2 diabetic subjects treated with diet and SU, aged 44-69 years and a duration of diabetes of between 2 and 14 years.


METHODS
Individually adjusted doses of insulin and glibenclamide.


METHODS
Glycosylated haemoglobin (HbA1c), insulin resistance (euglycaemic glucose clamp), levels of lipids, lipoproteins and blood pressure.


RESULTS
Glycaemic control improved during insulin treatment, but deteriorated on SU; HbA1c levels differed significantly between groups after 12 months of therapy (mean +/- SEM 7.9 +/- 0.3 vs. 9.5 +/- 0.4%, P = 0.004). Body mass index increased significantly during insulin treatment (26.4 +/- 0.7 to 27.8 +/- 0.7 kg/m2, P = 0.0001) and 30% of this increase was a result of an increase in lean body mass. The total glucose disposal rate showed a small increase in the insulin group. Levels of triglycerides and apolipoprotein B were significantly reduced during insulin treatment (1.8 +/- 0.2 to 1.5 +/- 0.2 mmol L-1, P = 0.03 and 1.58 +/- 0.1 to 1.40 +/- 0.08 g L-1, P = 0.003), and insulin prevented a reduction in the levels of high-density lipoprotein (HDL) cholesterol and apolipoprotein A-1 and an increase in Lp(a) lipoprotein observed in the SU group. Blood pressure levels did not change during therapy.


CONCLUSIONS
Insulin therapy was superior to SU treatment in achieving good metabolic control. Despite a modest improvement in cardiovascular risk factors in the insulin-treated group, no significant differences were observed between the groups after 1 year's treatment.
Birkeland
K I
KI
Hormone Laboratory, Aker Hospital, Oslo, Norway.
Hanssen
K F
KF
Urdal
P
P
Berg
K
K
Vaaler
S
S
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D015309:Glucose Clamp Technique; D005905:Glyburide / Q000494:pharmacology* / Q000627:therapeutic use; D006442:Glycated Hemoglobin / Q000187:drug effects; D006801:Humans; D007328:Insulin / Q000494:pharmacology* / Q000627:therapeutic use; D007333:Insulin Resistance / Q000502:physiology; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D005905:Glyburide; D006442:Glycated Hemoglobin; D007328:Insulin; D008055:Lipids