Comparison of continual insulin or secretagogue treatment in type 2 diabetic patients with alternate insulin-secretagogue administration.
BACKGROUND
To compare the compliance and efficacy among three treatment modalities in patients of type 2 diabetes with fairly good islet function.


METHODS
This 38-month open, randomized, prospective study enrolled 536 subjects (HbA1c 9.4+/-0.8%). Patients were divided into three groups including continual insulin injection (I), continual secretagogue administration (S) and alternation of two-month insulin injection and four-month secretagogue treatment (A). At baseline and every three months, HbA1c was measured and a standard bread meal test (100g) was performed.


RESULTS
HbA1c were better controlled in both groups I and A than in S (6.9+/-0.3%, 6.8+/-0.3% vs. 7.6+/-0.5%). Hypoglycemia incidence was much lower in group A than that in I (0.8 times/patient/month vs. 2.4 times/patient/month) also with less weight gain (1.6 kg vs. 2.8 kg/patient/year). From the standard bread meal test, patients in group A got the greatest increment of 2-h C-peptide. Inquiry from all subjects showed that alternate strategy was welcomed by most of them considering for convenience and efficacy.


CONCLUSIONS
Alternate insulin-secretagogue treatment can effectively reduce HbA1c and help to improve islet function with reduced risk of hypoglycemia and weight gain under good compliance.
Li
Hong
H
Department of Endocrine and Metabolism, Shanghai Tenth Hospital Affiliated to Tongji University, 301# Middle YanChang Road, Shanghai 200072, China. [corrected]
Li
Wenjun
W
Gu
Yao
Y
Han
Yuqi
Y
Wang
Jiying
J
Xu
Bei
B
Li
Fang
F
Yu
Yongchun
Y
Wu
Guoting
G
D000284:Administration, Oral; D017668:Age of Onset; D000410:Alanine Transaminase / Q000097:blood; D001806:Blood Urea Nitrogen; D015992:Body Mass Index; D002096:C-Peptide / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007267:Injections; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies
D000410:Alanine Transaminase; D002096:C-Peptide; D003404:Creatinine; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin