NIDDM - A RAPID PROGRESSIVE DISEASE - RESULTS FROM A LONG-TERM, RANDOMIZED, COMPARATIVE-STUDY OF INSULIN OR SULFONYLUREA TREATMENT

The objective of the present study was to assess the relative efficacy of insulin or glibenclamide treatment for non-insulin-dependent diabe tes mellitus (NIDDM) over 42 months. We performed a randomised, contro lled trial allocating patients treated with diet and oral antihypergly caemic agents to treatment with glibenclamide or insulin to achieve Hb A(1c) levels under 7.5 %. We included 36 subjects with established NID DM of more than 2 years' duration. Mean HbA(1c) levels were significan tly reduced in patients allocated to insulin treatment from 9.1 +/- 1. 4 % before the start to 7.8 +/- 1.3 % (p < 0.05) after 1 year, and did not change significantly thereafter throughout the study period. Mean HbA(1c) levels increased during the study in the patients allocated t o glibenclamide treatment, and 11 of 18 patients had to be switched to insulin treatment due to increasing hyperglycaemia (HbA(1c) > 10 %). Mean body weight increased in the subjects allocated to insulin by 7.2 +/- 4.1 kg during the study period. In conclusion, insulin was more e ffective than glibenclamide treatment in obtaining control over hyperg lycaemia in these patients, and once improved, glycaemic control did n ot deteriorate over 42 months in the insulin-treated group. Two thirds of the patients allocated to glibenclamide treatment had to be given insulin due to inadequate glycaemic control.