Comparison of Gliclazide with Insulin as Initial Treatment Modality in Newly Diagnosed Type 2 Diabetes

Abstract

Comparable glycemic control could be achieved with both insulin and oral hypoglycemic agent in newly diagnosed type 2 diabetes subjects. Insulin treatment exceeded gliclazide in the remission (drug-free) rate.

Type 2 Diabetes Increases Risk for Obesity Among Subsequent Generations

“…45 We also observed weight loss when individuals with type 2 diabetes went into remission following insulin therapy. 46 Our own observations and historical evidence suggest that hyperinsulinemia is possibly the first indication of metabolic derangement in an individual destined to develop diabetes. Insulin may, by its action on the brain, induce behavior and=or lifestyle conducive to obesity.…”

Pro's and Con's of the early use of insulin in the management of type 2 diabetes: a clinical evaluation

“…I think not for several reasons. First, patients started on insulin were either hospitalized [6,7,9,10] or contacted their physicians daily [8,11] or every several days [13]. This is simply not feasible in current western medical care systems.…”

“…This is simply not feasible in current western medical care systems. Second, newly diagnosed type 2 diabetic patients treated with OAD achieved and maintained goal Hb A1c levels ([11,13–15]. Third, although insulin will certainly bring a patient under control, compare what is required from physicians and patients when insulin or OAD are started (Table 2).…”

“…Finally, even though the ADA recommends insulin therapy in severely hyperglycemic, symptomatic type 2 diabetic patients [22], it really isn’t necessary under these circumstances. High doses of a SU will quickly bring these patients under control [13,14,23] as rapidly as insulin [13,14]. Severely hyperglycemic, newly diagnosed type 2 diabetic patients are often hospitalized and started on insulin at my county institution and invariably have near euglycemia (and often hypoglycemia) when first seen in our diabetes clinic.…”

“…Chandra and colleagues [13] explained treatment options and the possibility of long term benefits of insulin therapy to newly diagnosed type 2 diabetic patients with fasting blood glucose (FBG) concentrations >200 mg/dl and allowed them to choose between an SU or insulin, enrolling 30 in each group. Patients selecting the SU were started on 60 mg of gliclazide-MR once a day and advised to perform self monitoring of blood glucose (SMBG) before breakfast and at bedtime.…”