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Item
#11
Insulin Improves Glycemic Control when Sulfonylurea Fails
The effect
of insulin addition when maximal sulfonylurea therapy was
inadequate in patients with type 2 diabetes.
A group of
researchers led by Dr Wright from the University Hospital
Birmingham, studied the effect of insulin addition when maximal
sulfonylurea therapy was inadequate in patients with type 2
diabetes.
Overall, 826
patients were randomly assigned to glucose control with diet,
insulin alone, or sulfonylurea with or without insulin. Patients
who were randomly assigned to sulfonylurea were given insulin if
their fasting plasma glucose remained >108mg/dL despite maximal
sulfonylurea doses.
The
researchers showed that after 6 years 53% of patients randomized
to sulfonylurea required additional treatment with insulin.
Patients in the sulfonylurea-insulin group had significantly lower
median HbA1c levels (6.6%) than patients in the
insulin-alone group (7.1%, p=0.0066), and significantly more
patients in the sulfonylurea-insulin group maintained an HbA1c
level <7% than patients in the insulin-alone group (47 vs 35%,
p=0.011). Weight gain was similar in patients in the insulin-alone
and sulfonylurea groups.
Major
episodes of hypoglycemia occurred less frequently in patients in
the sulfonylurea-insulin group compared with those in the
insulin-alone group (1.6 vs 3.2% per annum, p=0.017).Diabetes
Care 2002;25:330-6
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Did
You Know:
Diabetes Care December, 1997
–“Charges for medical care for patients with
diabetes from 1993 to 1995 were closely related to HbA1c levels.
The medical charge data suggest that investment in clinical
systems to improve diabetes care may be benefit both payers and
patients”
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