MEDICATION CONSUMPTION IN DIABETES-MELLITUS (VI) - ECONOMICS AND EFFECTIVENESS OF INSULIN AND SULFONYLUREA COMBINATION THERAPY COMPARED WITH CONVENTIONAL 2 DAILY DOSES

BACKGROUND: TO compare the cost and effectiveness of bedtime intermedi ate-acting insulin and daytime-sulfonylurea (SU) combination therapy v ersus the conventional two-daily-dose insulin treatment. SUBJECTS, MAT ERIAL AND METHODS: A pharmacoeconomical analysis of cost minimization. To prove a similar effectiveness a transversal prospective study was carried out. Patients recently converted to insulin due to oral hypogl ycaemic agents failure were recruited. Entry criteria were: age > 40 y ears-old, more than 3 and 1 years of diagnosed diabetes and follow-up, respectively, current BMI between 20-40 kg/m(2), baseline HbA(1c) > 8 .5% and fasting C-peptide > 0.3 nmol/l. BMI, HbA(1c), hypoglycaemic cr isis, insulin and SU (glicazide and glibenclamide) daily dose were rec orded, estimating the cost of both therapies. RESULTS: Sixty-five pati ents (23 male), 32 in combined therapy (mean daily dose of insulin 19. 5 U and 2.4 SU tb t.i.d.) and 33 patients with a two-insulin-injection regimen (38.4 U) were treated during a follow-up period of 2.4 years. The two groups exhibited similar mean age (67.8/67.7y), known diabete s duration (15.9/15.1y), BMI (28.9/28.8/kg/m(2)), previous HhA(1c) (8. 9/9.1%) and fasting C-peptide (1.6/1.2 nmol/l). No statistical differe nces in BMI increase (1/1.4 kg/m(2)), neither in mean HbA(1c) (7.8/7.9 %) nor severe hypoglycaemic crisis (0.03/0.17 episodes/year) were evid enced. Patients in combined therapy reported a lower number of mild hy poglycaemic crisis (0.7/1.9 episodes/month; p < 0.01) and the daily co st was significantly lower (94.5/134.3 ptas./day; p < 0,0001). CONCLUS IONS: Both therapies, two-insulin-infection regimen and insulin and su lfonylurea combination therapy were similarly effective in having an a cceptable glycaemic control with similar risk for: weight gain or seve re hypoglycaemia. Combined therapy was more cost-effective and well-to lerated, thus, comfort and a lower risk of mild hypoglycaemic episodes were evidenced.