DAYTIME GLIBENCLAMIDE AND BEDTIME NPH INSULIN COMPARED TO INTENSIVE INSULIN-TREATMENT IN SECONDARY SULFONYLUREA FAILURE - A 1-YEAR FOLLOW-UP

The aim of this study was to compare the metabolic effects of a combin ation of daytime glibenclamide and evening NPH insulin with intensive insulin treatment (rapid acting insulin before meals and NPH insulin a t bedtime) in patients exhibiting secondary failure to sulphonylurea t reatment. Thirty-nine mildly obese NIDDM patients (BMI 25.6 +/- 0.5) w ere randomized after 6 weeks of intensive insulin treatment to either a combination treatment (CT, n = 20) or continued intensive insulin tr eatment (IT, n = 19). There were no differences between the two groups in age, diabetes duration, BMI, HbA(1c), or basal and glucagon stimul ated C-peptide. The patients were followed for 1 year and the findings were analysed on an intent to treat basis. Two patients in the CT gro up were excluded after 2 and 6 months, respectively, due to unacceptab ly high postprandial glucose values. There was a significant differenc e in HbA,, between the CT and IT groups at 6 months (8.2 +/- 0.2, n = 19, vs 6.8 +/- 0.4 %, n = 19, p < 0.001)), but not at 12 months (7.8 /- 0.3, n = 18, vs 7.5 +/- 0.4%, n = 19). After the initial intensive insulin treatment, BMI was constant in the CT group but increased sign ificantly at 6 and 12 months in the IT group. We conclude that both tr eatments are associated with a marked and long-term improvement of gly caemic control. The intensive insulin treatment leads to a more pronou nced weight increase which in the long run might have negative effect on overall metabolic control. Therefore, the combination treatment tog ether with intensified education and dietary advice should be regarded as the initial treatment of choice for oral agent failure in moderate ly obese NIDDM patients.