INSULIN VERSUS A COMBINATION OF INSULIN AND SULFONYLUREA IN THE TREATMENT OF NIDDM PATIENTS WITH SECONDARY ORAL FAILURE

Aim: Comparison of the effectiveness of combined therapy vs. an insuli n regimen in NIDDM patients with secondary failure of oral hypoglycemi c agents. Research design, patients and method;: 27 NIDDM patients wer e randomly allocated to Group A (n = 14, insulin) and Group B (n = 13, insulin and sulfonylurea) with crossover after 3 months. After the ne xt 3 months a decision was made about the further treatment according to the metabolic control. The patients were then treated for another y ear with the more successful regimen. Metabolic control, residual beta -cell secretory capacity, degree of peripheral insulin resistance (cla mp) and insulin dose were followed during the whole study. Results. (m edian, interquartile range, in brackets; , statistically significant difference at P < 0,05): the combined therapy was better then insulin alone in 2/3 of patients. Glycemic control was better (HbA(1c) at 3 mo nths: Group A = 7.9(1.1)% vs. Group B = 7.0(0.5)%; HbA(1c), at 6 mont hs: Group A = 7.4(1.5)% vs. Group B = 8.1(1.5)%. Insulin dose was lowe r during the combined therapy in the first 3 months: Group A = 0.62(0. 18) U/kg body weight vs. Group B = 0.39(0.16) U/kg body weight. Combi ned treatment was associated with increased C-peptide excretion both f asting and postprandially. No significant differences in peripheral in sulin resistance were noted between the two groups. The combined treat ment remained successful even after one year. The two groups of patien ts with different effective treatment did not differ significantly in any of the observed parameters. Conclusions: the combined therapy was more effective than insulin alone. Its favourable effect persisted aft er treatment for a year. It seems better to start the treatment of the oral failure with combined therapy compared with insulin first and la ter followed by combined therapy. On the basis of the observed paramet ers it is impossible to determine in advance which kind of treatment i s more suitable for the individual patient.