Although the addition of sulfonylureas to metformin therapy improves glycemic control in type 2 diabetics, deterioration may resume in as little 6 months’ "This study confirms the year-on-year rise in glycemia reported by the UK Prospective Diabetes Study and that the addition of a sulfonylurea to metformin, despite short term benefits, does not alter this trend," said senior investigator Dr. Rury R. Holma.
Dr. Holman of the University of Oxford, UK and colleagues note that such combination therapies are being increasingly used to maintain target plasma glucose levels, but little is known about glycemic control over time.
To investigate further, the researchers conducted a retrospective analysis of the records of 2220 patients in a UK general practice database. All had been treated for more than 90 days with metformin monotherapy before going on to combination therapy with sulfonylureas.
At 6 months after the start of combination therapy, median hemoglobin A1c started to deteriorate at a rate comparable to that seen on monotherapy. Among factors predictive of increasing A1c, were being young, female and a former smoker.
The researchers estimated that 85% of patients would have an A1c of 8.0% or higher 4 years after starting sulfonylureas. This, they also estimated to be the case in 68% of patients 4 years after achieving an A1c of less than 7% on combination therapy.
Dr. Holman noted that "the progressive loss of glycemic control is thought to be due to a declining insulin secretory capacity, with the findings reported here emphasizing the need to identify treatments that can maintain or restore beta cell function."
Diabetes Care 2005;28:995-1000.
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