Twice daily insulin therapy in patients with type-2 diabetes and secondary failure to sulfonylureas


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In 26 type 2 diabetic patients with failure to diet and sulphonylureas (fasting blood glucose levels > 8.0 mmol/l) the effects of insulin therapy on blood glucose control, islet B-cell function and plasma lipids were studied. Age was 58 +/- 11 (SD) yr, median duration of diabetes 6.5, range 1-24 yr, and body mass index 24.5, range 18.9-36.3 kg/m2. Six patients were obese. Therapy comprised twice daily injections of intermediate-acting insulin with additional fast-acting insulin when necessary. After six months, insulin dose was 39 +/- 10 U in the non-obese patients. Their fasting (14.0 +/- 2.7 mmol/l) and post-prandial blood glucose (17.9 +/- 4.5 mmol/l) and glycosylated haemoglobin (HbA1, 13.0 +/- 2.0%) declined to 7.7 +/- 1.6 mmol/l, 10.6 +/- 2.6 mmol/l and 9.5 +/- 1.0%, respectively (p < 0.001). Median body weight increased by 3.7 kg (p < 0.001). The changes in body weight correlated well with the changes in fasting blood glucose (r = -0.75, p < 0.01) and HbA1 (r = -0.73, p < 0.01). Fasting plasma insulin increased (p < 0.01), whereas fasting plasma C-peptide and C-peptide release after glucagon did not change. Free fatty acids, LDL-cholesterol, total and VLDL-triglycerides showed a significant (p < 0.05) decrease during insulin treatment. In the six obese patients insulin dose after six months was 44 +/- 18 U. Fasting blood glucose fell from 11.3 +/- 2.2 to 8.8 +/- 2.7 mmol/l (p < 0.01), and HbA1 decreased from 10.7 +/- 1.1% to 9.8 +/- 1.3% (p < 0.01). Body weight remained unchanged. Fasting C-peptide levels decreased (p < 0.01), whereas neither insulin levels nor lipid parameters showed significant changes. Almost all patients reported improved well-being. One patient had a hypoglycaemic period, requiring medical assistance. We conclude that insulin therapy in type 2 diabetic patients failing on sulphonylurea therapy improved metabolic control with a slight improvement of lipid profile, despite a concomitant gain of weight.

Originele taal-2English
Pagina's (van-tot)79-84
Aantal pagina's6
TijdschriftDiabetes research clinical and experimental
Nummer van het tijdschrift2
StatusPublished - feb-1990
Extern gepubliceerdJa

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