ONE-YEAR RESPONSE TO EVENING INSULIN THERAPY IN NONINSULIN-DEPENDENT DIABETES

We studied the 1-year response and predictors of the response to combi nation therapy with evening insulin and oral agents in NIDDM patients with a secondary failure. Injection of intermediate-acting (Monotard H M) or long-acting (Ultratard HM) insulin was added to previous oral th erapy in 17 diabetics (of mean age (+/- SD) 54 +/- 2 years, BMI 27.6 /- 0.5 kg m-2). The initial insulin dose was in the range 10(-16) U. a nd the mean dose was 23 +/- 2 U d-1 at 12 months. During the year, com bination therapy reduced the mean fasting blood glucose concentration (12.7 +/- 0.6 vs. 8.4 +/- 0.7 mmol l-1, P < 0.001) and HbA1 (10.7 +/- 0.3 vs. 9.8 +/- 0.4%, P < 0.01). Body weight increased by 4.4 +/- 0.7 kg (P < 0.001). The serum cholesterol concentration decreased by 14% ( P < 0.01). but serum triglyceride and HDL-cholesterol levels remained unchanged. Elevation of serum triglycerides and plasma free fatty acid s (FFAs) at baseline predicted a poor long-term outcome to this mode o f therapy. in conclusion, the addition of evening injections of insuli n to oral therapy improves glycaemic control in poorly controlled NIDD M patients. However, initial hypertriglyceridaemia predicts a poor lon g-term outcome to evening insulin supplementation.