Comparison of Combined Therapies in Treatment of Secondary Failure to Glyburide

Trischitta, Vincenzo; Italia, Salvatore; Mazzarino, S.; Buscema, Massimo; Rabuazzo, Agata Maria; Sangiorgio, L.; Squatrito, Sebastiano; Vigneri, Riccardo

doi:10.2337/diacare.15.4.539

Cited by 42 publications

(11 citation statements)

References 9 publications

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“…1 U/kg. The weight gain of 2.4 ± 0.7 kg was comparable with or less than those recorded in previously reported insulin therapy trials of 2-6 months' duration in NIDDM patients (25)(26)(27)(28)(29)(30)(31)(32)(33), as well as in studies that have combined bedtime insulin with a sulfonylurea (7,8,10,11,14). One should use the smallest effective insulin doses to avoid increased risk of hypoglycemia and hyperinsulinemia, with increased potential risk of atherogenesis and excessive weight gain (30).…”

Section: Figure 3-24-h Plasma Glucose Level A: Total 24-h Plasma Glusupporting

confidence: 63%

“…Although previous clinical trials have used bedtime insulin in NIDDM subjects (6)(7)(8)(9)(10)(11)(12)(13), normal fasting plasma glucose (FPG) or glucose levels <140 mg/dl rarely have been achieved. In a recent study comparing different insulin regimens in these patients (14), bedtime insulin was found to cause less hyperinsulinemia and weight gain but a similar incidence of hypoglycemia.…”

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confidence: 99%

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Safety and Efficacy of Normalizing Fasting Glucose With Bedtime NPH Insulin Alone in NIDDM

1995

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NPH insulin given at bedtime in amounts sufficient to achieve a normal FPG level does not cause excessive or severe hypoglycemia and does lead to good glycemic and lipid control in NIDDM. Bedtime insulin therapy also is accompanied by improved insulin secretion and insulin sensitivity. We conclude that a single dose of insulin alone at bedtime merits consideration as a therapeutic strategy in patients with poorly controlled NIDDM.

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Section: Figure 3-24-h Plasma Glucose Level A: Total 24-h Plasma Glusupporting

confidence: 63%

mentioning

confidence: 99%

Safety and Efficacy of Normalizing Fasting Glucose With Bedtime NPH Insulin Alone in NIDDM

1995

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“…In patients with type 2 diabetes mellitus who remain hyperglycaemic when treated with a sulphonylurea drug, the co-prescription of metformin has been shown to give increased efficacy in terms of lowering blood glucose levels [5,[18][19][20]. Potentially favourable effects on blood lipid concentrations and haemostatic activity have also been reported [21], and weight gain may be minimized in obese subjects [21].…”

Section: Discussionmentioning

confidence: 99%

Mortality in type 2 diabetic subjects prescribed metformin and sulphonylurea drugs in combination: cohort study

Gulliford

Latinovic

2004

Diabetes Metabolism Res

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“…Combination therapy using sulfonylurea agents and metformin and/or troglitazone has been shown to improve blood glucose control compared with monotherapy (27)(28)(29)(30). The use of metformin or troglitazone in combination with insulin has also demonstrated improved blood glucose control over insulin therapy alone (31)(32)(33)(34).…”

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confidence: 99%

Comparison of Insulin Monotherapy and Combination Therapy With Insulin and Metformin or Insulin and Troglitazone in Type 2 Diabetes

2002

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OBJECTIVE—To evaluate the safety and efficacy of treatment with insulin alone, insulin plus metformin, or insulin plus troglitazone in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS—A total of 88 type 2 diabetic subjects using insulin monotherapy (baseline HbAlc 8.7%) were randomly assigned to insulin alone (n = 31), insulin plus metformin (n = 27), or insulin plus troglitazone (n = 30) for 4 months. The insulin dose was increased only in the insulin group. Metformin was titrated to a maximum dose of 2,000 mg and troglitazone to 600 mg. RESULTS—HbAlc levels decreased in all groups, the lowest level occurring in the insulin plus troglitazone group (insulin alone to 7.0%, insulin plus metformin to 7.1%, and insulin plus troglitazone to 6.4%, P < 0.0001). The dose of insulin increased by 55 units/day in the insulin alone group (P < 0.0001) and decreased by 1.4 units/day in the insulin plus metformin group and 12.8 units/day in the insulin plus troglitazone group (insulin plus metformin versus insulin plus troglitazone, P = 0.004). Body weight increased by 0.5 kg in the insulin plus metformin group, whereas the other two groups gained 4.4 kg (P < 0.0001 vs. baseline). Triglyceride and VLDL triglyceride levels significantly improved only in the insulin plus troglitazone group. Subjects taking metformin experienced significantly more gastrointestinal side effects and less hypoglycemia. CONCLUSIONS—Aggressive insulin therapy significantly improved glycemic control in type 2 diabetic subjects to levels comparable with those achieved by adding metformin to insulin therapy. Troglitazone was the most effective in lowering HbAlc, total daily insulin dose, and triglyceride levels. However, treatment with insulin plus metformin was advantageous in avoiding weight gain and hypoglycemia.

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Comparison of Combined Therapies in Treatment of Secondary Failure to Glyburide

Abstract: The addition of bedtime NPH insulin or metformin was effective in improving the glycemic control in most NIDDM patients with secondary failure to glyburide. The combination of metformin and sulfonylurea was more effective in reducing PPPG and did not induce any increase of body weight.

Cited by 42 publications

References 9 publications

Safety and Efficacy of Normalizing Fasting Glucose With Bedtime NPH Insulin Alone in NIDDM

Safety and Efficacy of Normalizing Fasting Glucose With Bedtime NPH Insulin Alone in NIDDM

Mortality in type 2 diabetic subjects prescribed metformin and sulphonylurea drugs in combination: cohort study

Comparison of Insulin Monotherapy and Combination Therapy With Insulin and Metformin or Insulin and Troglitazone in Type 2 Diabetes

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