title: Beneficial effects of insulin versus sulphonylurea on insulin secretion and metabolic control in recently diagnosed type 2 diabetic patients.
abstract: OBJECTIVE
  To evaluate whether treatment with insulin in recently diagnosed type 2 diabetes is advantageous compared with glibenclamide treatment.
  
  
  METHODS
  Beta-cell function, glycemic control, and quality of life were monitored over 2 years in 39 patients with islet cell antibody-negative type 2 diabetes diagnosed 0-2 years before inclusion in a Swedish multicenter randomized clinical trial. Patients were randomized to either two daily injections of premixed 30% soluble and 70% NPH insulin or glibenclamide (3.5-10.5 mg daily). C-peptide-glucagon tests were performed yearly in duplicate after 2-3 days of temporary withdrawal of treatment.
  
  
  RESULTS
  After 1 year the glucagon-stimulated C-peptide response was increased in the insulin-treated group by 0.14 +/- 0.08 nmol/l, whereas it was decreased by 0.12 +/- 0.08 nmol/l in the glibenclamide group, P < 0.02 for difference between groups. After 2 years, fasting insulin levels were higher after treatment withdrawal in the insulin-treated versus the glibenclamide-treated group (P = 0.02). HbA(1c) levels decreased significantly during the first year in both groups; however, at the end of the second year, HbA(1c) had deteriorated in the glibenclamide group (P < 0.01), but not in the insulin-treated group. The difference in evolution of HbA(1c) during the second year was significant between groups, P < 0.02. A questionnaire indicated no difference in well-being related to treatment.
  
  
  CONCLUSIONS
  Early insulin versus glibenclamide treatment in type 2 diabetes temporarily prolongs endogenous insulin secretion and promotes better metabolic control.
authors.affiliation: Department of Endocrinology and Diabetology, Karolinska Hospital, Stockholm, Sweden. michael.alvarsson@ks.se
authors.forename: Michael
authors.initials: M
authors.lastname: Alvarsson
authors.forename: Göran
authors.initials: G
authors.lastname: Sundkvist
authors.forename: Ibe
authors.initials: I
authors.lastname: Lager
authors.forename: Marianne
authors.initials: M
authors.lastname: Henricsson
authors.forename: Kerstin
authors.initials: K
authors.lastname: Berntorp
authors.forename: Eva
authors.initials: E
authors.lastname: Fernqvist-Forbes
authors.forename: Lars
authors.initials: L
authors.lastname: Steen
authors.forename: Gunilla
authors.initials: G
authors.lastname: Westermark
authors.forename: Per
authors.initials: P
authors.lastname: Westermark
authors.forename: Thomas
authors.initials: T
authors.lastname: Orn
authors.forename: Valdemar
authors.initials: V
authors.lastname: Grill
mesh_terms: D000328:Adult; D000368:Aged; D000682:Amyloid / Q000097:blood; D001786:Blood Glucose; D001835:Body Weight / Q000187:drug effects; D002096:C-Peptide / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005934:Glucagon / Q000097:blood; D005905:Glyburide / Q000008:administration & dosage* / Q000009:adverse effects; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism*; D000078790:Insulin Secretion; D058228:Islet Amyloid Polypeptide; D007515:Islets of Langerhans / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011384:Proinsulin / Q000097:blood; D011788:Quality of Life
chemical_list: D000682:Amyloid; D001786:Blood Glucose; D002096:C-Peptide; D008076:Cholesterol, HDL; D005934:Glucagon; D005905:Glyburide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D058228:Islet Amyloid Polypeptide; D011384:Proinsulin