Comparison of Morning or Bedtime Insulin With and Without Glyburide in Secondary Sulfonylurea Failure

Soneru, Ileana; Agrawal, Lily; Murphy, Jimmy; Lawrence, A. M.; Abraira, Carlos

doi:10.2337/diacare.16.6.896

Cited by 28 publications

(13 citation statements)

References 15 publications

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“…When SU was withdrawn (phase 3), a 50% increase in insulin dose was observed, as also reported in other studies (9,11,(14)(15)(16)(17)21,22). Despite this increment, only three patients among those who responded to combined therapy maintained their FPG below 140 mg/dl in phase 3 (P<0.02).…”

Section: Discussionsupporting

confidence: 64%

Gliclazide and bedtime insulin are more efficient than insulin alone for type 2 diabetic patients with sulfonylurea secondary failure

Chazan

Gomes

2001

Braz J Med Biol Res

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To determine the effects of combined therapy of gliclazide and bedtime insulin on glycemic control and C-peptide secretion, we studied 25 patients with type 2 diabetes and sulfonylurea secondary failure, aged 56.8 ± 8.3 years, with a duration of diabetes of 10.6 ± 6.6 years, fasting plasma glucose of 277.3 ± 64.6 mg/dl and a body mass index of 27.4 ± 4.8 kg/m 2 . Patients were submitted to three therapeutic regimens lasting 2 months each: 320 mg gliclazide (phase 1), 320 mg gliclazide and bedtime NPH insulin (phase 2), and insulin (phase 3). At the end of each period, glycemic and C-peptide curves in response to a mixed meal were determined. During combined therapy, there was a decrease in all glycemic curve values (P<0.01). Twelve patients (48%) reached fasting plasma glucose <140 mg/dl with a significant weight gain of 64.8 kg (43.1-98.8) vs 66.7 kg (42.8-101.4) (P<0.05), with no increase in C-peptide secretion or decrease in HbA1. CPeptide glucose score (C-peptide/glucose x 100) increased from 0.9 (0.2-2.1) to 1.3 (0.2-4.7) during combined therapy (P<0.01). Despite a 50% increase in insulin doses in phase 3 (12 U (9-30) vs 18 U (11-60); P<0.01) only 3 patients who responded to combined therapy maintained fasting plasma glucose <140 mg/dl (P<0.02). A tendency to a higher absolute increase in C-peptide (0.99 (0.15-2.5) vs 0.6 (0-2.15); P = 0.08) and C-peptide incremental area (2.47 (0.22-6.2) vs 1.2 (0-3.35); P = 0.07) was observed among responders. We conclude that combined therapy resulted in a better glucose response to a mixed meal than insulin alone and should be tried in type 2 diabetic patients before starting insulin monotherapy, despite difficulties in predicting the response.

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Section: Discussionsupporting

confidence: 64%

Gliclazide and bedtime insulin are more efficient than insulin alone for type 2 diabetic patients with sulfonylurea secondary failure

Chazan

Gomes

2001

Braz J Med Biol Res

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“…118 Metformin is discontinued, and the patient is continued on daytime sulfonylurea at a maximum dose. Self-monitoring of blood glucose is intensified and NPH insulin is added at bedtime.…”

Section: Bedtime Insulin/daytime Sulfonylurea Therapymentioning

confidence: 99%

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

et al. 1997

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PURPOSE:To summarize current knowledge of interventions that should improve the care of patients with type II diabetes mellitus. Interventions lie within the realms of prevention, screening, and treatment, all of which are focused on office practice. METHODS:Review of the literature by a multidisciplinary team involved in the care of patients with diabetes, followed by synthesis of the literature into a clinical care guideline. Literature was identified through consultation with experts and a focused MEDLINE search. MAIN RESULTS:An algorithm-based guideline for screening and treatment of the complications of diabetes was developed. The emphasis is on prevention of atherosclerotic disease, and prevention, screening, and early treatment of microvascular disease. Implementation of these practices has the potential to significantly improve quality of life and increase life expectancy in patients with type II diabetes mellitus. ype II diabetes is a common condition, affecting 2% to 3% of the adult population, and up to 20% to 25% of the elderly population. 1 Type II diabetes typically occurs in patients who are over 30 years old and weigh more than 120% of ideal body weight, and accounts for 90% of all cases of diabetes mellitus diagnosed in the United States. 1 Minorities have a prevalence of type II diabetes mellitus that is 2 to 6 times greater than that of white persons. The morbidity and mortality are higher for minorities than for white persons, and the rate is increasing. 2 The reasons for this disparity remain unclear, but could include differences in disease severity, comorbidities, or access to care.Diabetes has significant associated morbidity. Prevention and treatment of the complications of diabetes mellitus have the potential to improve quality of life and increase life expectancy. 3 The rate of cardiovascular disease is markedly elevated among patients with type II diabetes, leading to an increased mortality rate compared with the general population. 4,5 In addition, microvascular complications, which include retinopathy, nephropathy, and neuropathy, can progress to end-stage outcomes such as blindness, end-stage renal disease (ESRD), and amputation. Screening and early treatment for diabetic complications have been shown to be effective in reducing the incidence of end-stage disease 6,7 ; despite this evidence, implementation rates of recommended interventions are low. 8 This frequently leads to ineffective or delayed treatment of complications. 9-11 Because optimal diabetes care is a complex process, we developed a clinical care guideline to help busy clinicians incorporate prevention, screening, and treatment recommendations into practice. METHODSA multidisciplinary team was assembled to develop an evidence-based guideline for the prevention and treatment of complications of type II diabetes. The multidisciplinary team included members from endocrinology, family practice, general internal medicine, obstetrics-gyncecology, nursing, and postgraduate medicine departments. Team members have an interest ...

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“…The pros and cons of timing of the intermediate-acting insulin injection has been examined in three studies (15,33,34). In two studies, a bedtime injection was recommended because it resulted in less weight gain (15) or less hypoglycemias (34) than a morning injection.…”

Section: Timing Of the Intermediate-acting Insulin Injectionmentioning

confidence: 99%

Combination Therapies With Insulin in Type 2 Diabetes

2001

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Comparison of Morning or Bedtime Insulin With and Without Glyburide in Secondary Sulfonylurea Failure

Cited by 28 publications

References 15 publications

Gliclazide and bedtime insulin are more efficient than insulin alone for type 2 diabetic patients with sulfonylurea secondary failure

Gliclazide and bedtime insulin are more efficient than insulin alone for type 2 diabetic patients with sulfonylurea secondary failure

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

Combination Therapies With Insulin in Type 2 Diabetes

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