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Glycemic Control Deteriorates After Sulfonylureas Added to Metformin

After 6 months deterioration of glycemic control resumes following the addition of SUs to MF. To describe the course and predictors of glycemic control among patients with type 2 diabetes after sulfonylureas (SUs) are added to metformin (MF), 220 patients were treated with MF monotherapy for >90 days before initiating MF plus SU combination therapy. In a retrospective analysis of electronic medical records from U.K. primary care practices using the General Practice Research Database. Median glycoslyated hemoglobin A(1c) (A1C) before and after SU initiation was described, and patient characteristics were evaluated as predictors of time until A1C >/=8.0% or glucose-lowering therapy was intensified (by starting insulin or adding a third oral agent).

The results after 6 months post-SU initiation, median A1C resumed deteriorating at a somewhat comparable rate to that observed on MF monotherapy. Higher pre-SU A1C, younger age, female sex, shorter diabetes duration, higher serum creatinine, and being an ex-smoker predicted time until A1C >/=8.0% or glucose-lowering therapy was intensified in various analyses.

Median A1C was 9.5% when therapy was intensified. A1C >/=8.0% was estimated to occur in 85% of patients 4 years after SU initiation and in 68% 4 years after initially achieving A1C <7% on MF plus SU therapy.

From the results it was concluded that, glycemic control is improved following the addition of SUs to MF, but deterioration resumes as early as 6 months. The high proportion of patients remaining on MF plus SU therapy despite having A1C >/=8.0% suggests that there are significant barriers to starting insulin or adding a third agent when treatment goals are not achieved with this combination.
Diabetes Care. 2005 May;28(5):995-1000

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In the research conducted by Dr. Sandra O’Brien Cousins and his colleagues from the University of Alberta, Canada, most middle-aged exercisers said that without thinking too much about the need to exercise, they just lace up their shoes and get out there.
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May 2005 issue of Psychology of Sports and Exercise