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Insulin Beats Sulphonylurea in Early Diabetes Treatment

Insulin treatment achieves better results in patients with recent onset type 2 diabetes than does therapy with glibenclamide.

A group of researchers led by Dr Micheal Alvarsson from the Karolinska Hospital, Stockholm, Sweden, evaluated the effect of treatment with insulin compared with glibenclamide. A total of 39 patients with newly diagnosed islet cell antibody-negative type 2 diabetes were monitored over a period of 2 years for beta-cell function, glycemic control and quality of life. Patients were randomized to either premixed 30% soluble and 70% NPH insulin or glibenclamide (3.5-10.5mg daily). Tests to measure glucagon-stimulated C-peptide concentrations were performed once per year 2-3 days after temporary cessation of treatment.

The researchers found that the glucagon-stimulated C-peptide response in the insulin treatment group increased after 1 year by 0.14±0.08nmol/L, but decreased by 0.12±0.08nmol/L in patients in the glibenclamide group (p<0.02). After 2 years, fasting insulin levels in the insulin treatment group were higher than in the glibenclamide group (p=0.02). Both groups experienced a significantl decrease in HbA1c concentrations during the first year. By the end of the second year, however, HbA1c concentrations in the glibenclamide group had increased (p <0.01), but not in the insulin treatment group. A patient questionnaire indicated similar quality of life for both treatment regimens.

The researchers conclude that early treatment with insulin in patients with type 2 diabetes prolongs endogenous insulin secretion and promotes increased metabolic control, compared with glibenclamide.

Commenting on the findings, Dr. Alvarsson said that"if further studies corroborate and extend our results, this could lead to an earlier use of insulin in the treatment of type 2 diabetes mellitus."
If insulin treatment was started even earlier, he added, "we might have seen more lasting effects of insulin on beta-cell function." Diabetes Care 2003;26:2231-7

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Did YOU KNOW:
Researchers have reported that overweight elderly women are more likely than those who remain slim to suffer Alzheimer’s disease. This study provides the first significant evidence linking the growing obesity pandemic with the obesity pandemic with the increasingly common brain disorder (Arch Intern Med 2003 Jul 14: 163: 1524-08). The study, which followed several hundred elderly Swedish people for 18 years showed that women who were heavy at age 70 yr were clearly more likely to develop Alzheimer’s disease in their eighties.