THE USE OF GLIPIZIDE COMBINED WITH INTENSIVE INSULIN-TREATMENT FOR THE INDUCTION OF REMISSIONS IN NEW-ONSET ADULT TYPE-1 DIABETES

To determine if glipizide could enhance remission induction in new ons et type 1 diabetes compared to intensive insulin treatment alone, 27 p atients with type 1 diabetes were intensively treated in an open rando mized trial with subcutaneous injections for one month. The insulin wa s randomly either discontinued (Group A) or the insulin discontinued a nd glipizide begun (Group B). Three patients in Group A (22%) and 7 in Group B (54%, p < .05) underwent insulin-free remissions for 10.3 +/- 4.4 and 8.7 +/- 2.6 months, respectively (p = NS). Mean blood glucose levels during insulin treatment were lower in patients entering remis sions (94 +/- 3 mg/dl versus 102 +/- 5 mg/dl, p < 0.05). C-peptide lev els were performed 0, 4, 8, and 24 weeks after insulin treatment. When all patients were examined, mean stimulated C-peptide levels at 4 wee ks (0.58 +/- 0.09 pm/ml) were incrreased compared to time 0 (0.32 +/- 0.05 pm/ml, p < 0.02). Patients not entering remission had higher 4-we ek stimulated values (0.67 +/- 0.12 pm/ml) compared to time 0 values ( 0.29 +/- 0.06 pm/ml, p < .01), whereas remission patients' mean C-pept ide levels remained similar at 0, 4, 8 and 24 weeks. These data indica te that a) insulin treatment plus glipizide induces higher rates of re mission compared to intensive insulin treatment alone, b) the intensit y of initial metabolic control may be an important determinant for rem ission induction, and c) endogenous insulin secretion is not associate d with remission induction, suggesting that glipizide alters insulin s ensitivity or is immunomodulatory in the context of new onset type 1 d iabetes.