The combination of insulin and oral hypoglycaemic drugs: a continuous challenge.
A large number of studies have demonstrated the efficacy and usefulness of combining insulin and sulfonylurea therapy in Type 2 diabetic patients with secondary therapeutic failure. Better glycaemic profiles and/or decreased insulin needs, which are shown to persist after a maximum of 5 years, have been reported in diabetic patients on combination therapy. Residual beta-cell function appears to be a prerequisite for a favourable effect of combined therapy since the diabetics who continued to benefit from this were those whose C-peptide levels (both fasting and stimulated) remained greater than baseline. The concept of combined therapy might not be confined to sulfonylurea: the biguanide, metformin, has been found useful in obese diabetic patients with secondary failure. The combination of insulin with other new promising drugs or triple associations (insulin+sulfonylurea+biguanide) are also worth considering.
Quatraro
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Chair of Metabolic Diseases, Faculty of Medicine, Second University of Naples, Italy.
Giugliano
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D
D000284:Administration, Oral; D000368:Aged; D002986:Clinical Trials as Topic; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D013453:Sulfonylurea Compounds / Q000008:administration & dosage*; D017211:Treatment Failure
D007004:Hypoglycemic Agents; D007328:Insulin; D013453:Sulfonylurea Compounds