Beneficial effects of insulin versus sulphonylurea on insulin secretion and metabolic control in recently diagnosed type 2 diabetic patients.
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.
Alvarsson
Michael
M
Department of Endocrinology and Diabetology, Karolinska Hospital, Stockholm, Sweden. michael.alvarsson@ks.se
Sundkvist
Göran
G
Lager
Ibe
I
Henricsson
Marianne
M
Berntorp
Kerstin
K
Fernqvist-Forbes
Eva
E
Steen
Lars
L
Westermark
Gunilla
G
Westermark
Per
P
Orn
Thomas
T
Grill
Valdemar
V
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
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