Efficacy of Sulfonylureas with Insulin in Type 2 Diabetes Mellitus

Abstract

By lowering the daily insulin dose, sulfonylurea drugs appear to improve the sensitivity of exogenous insulin in subjects with type 2 diabetes mellitus manifesting lapse of glycemic control. Moreover, glimepiride appears to possess a greater insulin-sparing property than other sulfonylureas.

Iowa medicaid 2: lapse of glycemic control on abrupt transition from insulin glargine to insulin detemir in type 2 diabetes mellitus

“…Moreover, in the long term, there are always several untoward consequences of weight gain, e.g. cardiovascular outcomes which could not be addressed in these short term studies [21][22][23][24][25][26]. Lack of severe hypoglycemic events noted in this study among both groups is not an unusual finding in subjects with type 2 Diabetes (2).…”

“…Thus, use of detemir may adversely affect quality of life in the short term, since several studies have documented that higher the daily insulin dose, more frequent the daily injections and more the peaks of insulin during the day, greater is the occurrence of hypoglycemic events and greater is the weight gain [21][22][23][24][25][26]. Moreover, in the long term, there are always several untoward consequences of weight gain, e.g.…”

“…Lack of severe hypoglycemic events noted in this study among both groups is not an unusual finding in subjects with type 2 Diabetes (2). However, hypoglycemic events are likely to rise with a greater daily dose of insulin detemir used once daily and may be further exacerbated in subjects with twice daily administration because of induction of multiple daily insulin peaks in the circulation as documented in previous studies using other insulin's achieving peak concentrations [21][22][23][24][25][26].…”

Is β-cell failure in type 2 diabetes mellitus reversible?

“…[27–31] The markedly decreased β-cell function present at initial evaluation in our subjects may be attributed to suppression by long-term administration of exogenous insulin, especially in extremely high daily dose, as demonstrated in our recent study with various sufonylurea drugs. [32] Alternatively, the decline in β-cell function, especially in terms of postprandial insulin secretion, may also be attributed to extreme insulin resistance at the level of the β-cell itself in the presence of morbid obesity as has been described recently. [3334]…”

“…The role of recovery from inhibition by exogenous insulin, enhancement of insulin sensitivity in the peripheral tissue as well as at the level of β-cell itself, and remission from glucose toxicity in improvement in β-cell function are well established. [1–311262732] Decrease in clearance of C-peptide may be another possible mechanism but is unlikely since both renal and hepatic function remained intact at the time of the repeated OGTT. Alternatively, improvement in the recently recognized decline in the incretin effect in T2DM may have contributed to the reversal of β-cell failure as well.…”