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Effects of insulin vs. glibenclamide in recently diagnosed patients with type 2 diabetes: a 4-year follow-up

Alvarsson, M; Sundkvist, Göran LU ; Lager, I; Berntorp, Kerstin LU ; Fernqvist-Forbes, E; Steen, L; Örn, T; Holberg, M A; Kirksaether, N and Grill, V (2008) In Diabetes, Obesity and Metabolism 10(5). p.421-429
Abstract
Aim: To compare effects of early insulin vs. glibenclamide treatment on beta-cell function, metabolic control and quality of life (QL) in recently diagnosed patients with type 2 diabetes. Methods: Forty-nine patients with type 2 diabetes diagnosed 0-2 years before inclusion were randomized to two daily injections of premixed 30% soluble and 70% NPH insulin or glibenclamide at six diabetic clinics in Sweden. C-peptide-glucagon tests were performed yearly after 3 days of withdrawal of treatment. Results: Thirty-four patients completed 4 years of study. Daily dose of insulin was increased from 20.4 +/- 1.8 U at year 1 to 26.1 +/- 2.9 U at year 4 (p = 0.005). Glibenclamide dosage increased from 2.7 +/- 0.4 mg at year 1 to 4.5 +/- 0.8 mg at... (More)
Aim: To compare effects of early insulin vs. glibenclamide treatment on beta-cell function, metabolic control and quality of life (QL) in recently diagnosed patients with type 2 diabetes. Methods: Forty-nine patients with type 2 diabetes diagnosed 0-2 years before inclusion were randomized to two daily injections of premixed 30% soluble and 70% NPH insulin or glibenclamide at six diabetic clinics in Sweden. C-peptide-glucagon tests were performed yearly after 3 days of withdrawal of treatment. Results: Thirty-four patients completed 4 years of study. Daily dose of insulin was increased from 20.4 +/- 1.8 U at year 1 to 26.1 +/- 2.9 U at year 4 (p = 0.005). Glibenclamide dosage increased from 2.7 +/- 0.4 mg at year 1 to 4.5 +/- 0.8 mg at year 4 (p = 0.02). Weight increased more in insulin than in glibenclamide treated (+4.4 +/- 0.8 vs. +0.3 +/- 1.0 kg, p < 0.005). Following short-term withdrawal of treatment, the C-peptide responses to glucagon were significantly higher in the insulin vs. glibenclamide group at years 1 (p < 0.01) and 2 (p < 0.02). HbA1c improved identical during the first year but thereafter deteriorated in the glibenclamide group (p < 0.005 for difference at year 4). Ratios of proinsulin to insulin were higher during treatment in glibenclamide- vs. insulin-treated patients after year 2. QL after 4 years as measured by the MOS 36-item Short-Form Health Survey (SF-36) form was not significantly altered. Conclusions: In a 4-year perspective, beta-cell function deteriorated in both groups. However, deterioration occurred faster in the glibenclamide group, indicating that alleviating demands on secretion by insulin treatment is beneficial. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
insulin secretion, insulin, glibenclamide, beta-cell protection, diabetes mellitus
in
Diabetes, Obesity and Metabolism
volume
10
issue
5
pages
421 - 429
publisher
Wiley-Blackwell
external identifiers
  • wos:000254857200007
  • scopus:42149083835
ISSN
1462-8902
DOI
10.1111/j.1463-1326.2007.00719.x
language
English
LU publication?
yes
id
8dc6bed4-0765-4d2a-92fa-fbba09b0bdea (old id 1206462)
date added to LUP
2008-09-19 14:12:03
date last changed
2017-11-05 03:31:21
@article{8dc6bed4-0765-4d2a-92fa-fbba09b0bdea,
  abstract     = {Aim: To compare effects of early insulin vs. glibenclamide treatment on beta-cell function, metabolic control and quality of life (QL) in recently diagnosed patients with type 2 diabetes. Methods: Forty-nine patients with type 2 diabetes diagnosed 0-2 years before inclusion were randomized to two daily injections of premixed 30% soluble and 70% NPH insulin or glibenclamide at six diabetic clinics in Sweden. C-peptide-glucagon tests were performed yearly after 3 days of withdrawal of treatment. Results: Thirty-four patients completed 4 years of study. Daily dose of insulin was increased from 20.4 +/- 1.8 U at year 1 to 26.1 +/- 2.9 U at year 4 (p = 0.005). Glibenclamide dosage increased from 2.7 +/- 0.4 mg at year 1 to 4.5 +/- 0.8 mg at year 4 (p = 0.02). Weight increased more in insulin than in glibenclamide treated (+4.4 +/- 0.8 vs. +0.3 +/- 1.0 kg, p &lt; 0.005). Following short-term withdrawal of treatment, the C-peptide responses to glucagon were significantly higher in the insulin vs. glibenclamide group at years 1 (p &lt; 0.01) and 2 (p &lt; 0.02). HbA1c improved identical during the first year but thereafter deteriorated in the glibenclamide group (p &lt; 0.005 for difference at year 4). Ratios of proinsulin to insulin were higher during treatment in glibenclamide- vs. insulin-treated patients after year 2. QL after 4 years as measured by the MOS 36-item Short-Form Health Survey (SF-36) form was not significantly altered. Conclusions: In a 4-year perspective, beta-cell function deteriorated in both groups. However, deterioration occurred faster in the glibenclamide group, indicating that alleviating demands on secretion by insulin treatment is beneficial.},
  author       = {Alvarsson, M and Sundkvist, Göran and Lager, I and Berntorp, Kerstin and Fernqvist-Forbes, E and Steen, L and Örn, T and Holberg, M A and Kirksaether, N and Grill, V},
  issn         = {1462-8902},
  keyword      = {insulin secretion,insulin,glibenclamide,beta-cell protection,diabetes mellitus},
  language     = {eng},
  number       = {5},
  pages        = {421--429},
  publisher    = {Wiley-Blackwell},
  series       = {Diabetes, Obesity and Metabolism},
  title        = {Effects of insulin vs. glibenclamide in recently diagnosed patients with type 2 diabetes: a 4-year follow-up},
  url          = {http://dx.doi.org/10.1111/j.1463-1326.2007.00719.x},
  volume       = {10},
  year         = {2008},
}