Issue 96 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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