COMBINED THERAPY WITH INSULIN AND SULFONYLUREA FOR THE TREATMENT OF NEW-ONSET INSULIN-DEPENDENT DIABETES-MELLITUS

The progressive B-cell destruction at the onset of type 1 diabetes and the relevance of residual B-cell function to metabolic control prompt ed us to try to prevent further B-cell destruction in new-onset type 1 diabetic patients. Having already shown positive effects of sulfonylr eas in long-standing IDDM patients, we decided to try the association of gliclazide with insulin in newly diagnosed IDDM patients. Therefore , 22 patients were randomly assigned to either gliclazide, 160 mg/24 h , or placebo (in association with standard insulin treatment) from the third week since the onset of the disease. Patients were studied ever y 6 months for 18 months. The insulin need was similar in the two grou ps at time 0, but thereafter it steadily decreased in the GCZ group be coming at 6, 12 and 18 months, respectively 65%, 42% and 39% of that o f the PL group. The metabolic control was very similar in the two grou ps throughout the study. The residual B-cell function (fasting and pos t-breakfast C peptide), which was similar in the two groups at time 0, remained unchanged or improved in the GCZ group, whereas it decreased in the PL group. In conclusion, the combined insulin-gliclazide treat ment appeared to improve B-cell function during the first 18 months of type 1 diabetes, inducing a major reduction of the insulin need with respect to patients treated with insulin alone.