Beneficial Effects of Insulin Versus Sulphonylurea on Insulin Secretion and Metabolic Control in Recently Diagnosed Type 2 Diabetic Patients
OBJECTIVE -To evaluate whether treatment with insulin in recently diagnosed type 2 diabetes is advantageous compared with glibenclamide treatment. RESEARCH DESIGN AND METHODS -␤-Cell function, glycemic control, and quality of life were monitored over 2 years in 39 patients with islet cell antibody-negative type 2 diabetes diagnosed 0 -2 years before inclusion in a Swedish multicenter randomized clinical trial. Patients were randomized to either two daily injections of premixed 30% soluble and
... d 30% soluble and 70% NPH insulin or glibenclamide (3.5-10.5 mg daily). C-peptide-glucagon tests were performed yearly in duplicate after 2-3 days of temporary withdrawal of treatment. RESULTS -After 1 year the glucagon-stimulated C-peptide response was increased in the insulin-treated group by 0.14 Ϯ 0.08 nmol/l, whereas it was decreased by 0.12 Ϯ 0.08 nmol/l in the glibenclamide group, P Ͻ 0.02 for difference between groups. After 2 years, fasting insulin levels were higher after treatment withdrawal in the insulin-treated versus the glibenclamidetreated group (P ϭ 0.02). HbA 1c levels decreased significantly during the first year in both groups; however, at the end of the second year, HbA 1c had deteriorated in the glibenclamide group (P Ͻ 0.01), but not in the insulin-treated group. The difference in evolution of HbA 1c during the second year was significant between groups, P Ͻ 0.02. A questionnaire indicated no difference in well-being related to treatment. CONCLUSIONS -Early insulin versus glibenclamide treatment in type 2 diabetes temporarily prolongs endogenous insulin secretion and promotes better metabolic control. Abbreviations: GADA, GAD antibody; IA2, insulinoma-associated protein 2; IA-2A, IA2 antigen; ICA, islet cell anitbody; IAPP, islet amyloid polypeptide; LADA, latent autoimmune diabetes in adults; RIA, radioimmunoassay; UKPDS, U.K. Prospective Diabetes Study. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.