Smoking (also in habitual smokers) acutely impairs insulin action and leads to insulin resistance. Thus, smoking can be of importance for the development of the insulin resistance syndrome associated with risk for cardiovascular disease.

No abstract

No abstract

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 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. Diabetes Care 26:2231-2237, 2003I n type 2 diabetes, metabolic control deteriorates in most patients when the duration of diabetes increases (1). Decreased insulin secretion likely explains this deterioration in metabolic control (1,2). Decreased insulin secretion could be due to excessive secretory demands on the ␤-cells (1). If so, insulin treatment would be beneficial by providing relative "␤-cell rest." However, sulfonylurea drugs may exert negative effects by overstimulating ␤-cells. No studies, to our knowledge, have been performed that rigorously compare the effects of sulfonylurea versus insulin treatment on the deterioration of insulin secretion in type 2 diabetic patients. The U.K. Prospective Diabetes Study (UKPDS) (1) randomized patients at inclusion to insulin or sulfonylurea and documented a deterioration of insulin secretion after sulfonylurea; however, endogenous insulin secretion in the insulin-treated group was not evaluated due to ongoing insulin treatment.The main aim of this prospective study was to examine whether insulin versus glibenclamide treatment started soon after the diagnosis of type 2 diabetes is associated with better ␤-cell function. We furthermore tested whether the two treatments affected differently metabolic control and other clinically relevant parameters. We studied patients with recent onset of type 2 diabetes, after excluding latent autoimmune diabetes in adults (LADA) (3). RESEARCH...