Comparison of Insulin With or Without Continuation of Oral Hypoglycemic Agents in the Treatment of Secondary Failure in NIDDM Patients

Chow, Chun‐Chung; Tsang, L. W. W.; Sorensen, Jean Pierre; Cockram, Clive S.

doi:10.2337/diacare.18.3.307

Cited by 97 publications

(44 citation statements)

References 32 publications

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“…The combination of insulin at bedtime with sulphonylurea drugs, as advocated in NIDDM [24][25][26], followed by NPH-insulin twice daily, appeared to be an effective, feasible and safe therapy regimen. The incidence rate of severe hypoglycaemia was low, 0.019/patient year for the whole group and 0.064/insulin treated patient year.…”

Section: Discussionmentioning

confidence: 99%

Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

et al. 1997

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SummaryIn primary care it is difficult to treat the growing number of non-insulin-dependent diabetic (NIDDM) patients according to (inter)national guidelines. A prospective, controlled cohort study was designed to assess the intermediate term (2 years) effect of structured NIDDM care in general practice with and without 'diabetes service' support on glycaemic control, cardiovascular risk factors, general well-being and treatment satisfaction. The 'diabetes service', supervised by a diabetologist, included a patient registration system, consultation facilities of a dietitian and diabetes nurse educator, and protocolized blood glucose lowering therapy advice which included home blood glucose monitoring and insulin therapy. In the study group (SG; 22 general practices), 350 known NIDDM patients over 40 years of age (206 women; mean age 65.3 + SD 11.9; diabetes duration 5.9 + 5.4 years) were followed for 2 years. The control group (CG; 6 general practices) consisted of 68 patients (28 women; age 64.6 + 10.3; diabetes duration 6.3 + 6.4 years). Mean HbAtc (reference 4.3-6.1%) fell from 7.4 to 7.0% in SG and rose from 7.4 to 7.6 % in CG during follow-up (p = 0.004). The percentage of patients with poor control (HbAlc > 8.5 %) shifted from 21.4 to 11.7 % in SG, but from 23.5 to 27.9 % in CG (p = 0.008). Good control (HbAlc < 7.0 %) was achieved in 54.3 % (SG; at entry 43.4%) and 44.1% (CG; at entry 54.4%) (p = 0.013). Insulin therapy was started in 29.7 % (SG) and 8.8 % (CG) of the patients (p = 0.000) with low risk of severe hypoglycaemia (0.019/patient year). Mean levels of total and HDL-cholesterol (SG), triglycerides (SG) and diastolic blood pressure (SG + CG) and the percentage of smokers (SG) declined significantly, 'but the prevalence of these risk factors remained high. General well-being (SG) did not change during intensified therapy. Treatment satisfaction (SG) tended to improve. Implementation of structured care, including education and therapeutic advice, results in sustained good glycaemic control in the majority of NIDDM patients in primary care, with low risk of hypoglycaemia. Lowering cardiovascular risk requires more than reporting results and referral to guidelines. [Diabetologia (1997[Diabetologia ( ) 40: 1334[Diabetologia ( -1340

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Section: Discussionmentioning

confidence: 99%

Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

et al. 1997

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“…Weight gain, which seems to be proportional to the number of insulin injections used, can be counteracted by the inclusion of metformin in the treatment program. [13][14][15][16][17] A Medline search from 1966 to May 2001 did not show any previous similar clinical trial comparing different ways of treating type 2 diabetics based on the use of lispro insulin and metformin. The study by Bastry et al 38 confirms previous reports that improved glycemic control can occur when a second antihyperglycemic agent is added, regardless of the program.…”

Section: Discussionmentioning

confidence: 99%

“…There are several therapeutic schemes recommended for the treatment of type 2 diabetic patients. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Both non-insulinotropic and insulinotropic drugs are valid options for the crucial treatment of those patients with various pathophysiological origins of type 2 diabetes. 27 Because some degree of insulin deficiency is always present in an individual with diabetes type 2, we included metformin which is an agent known to influence insulin sensitivity without affecting insulin secretion.…”

Section: Discussionmentioning

confidence: 99%

Comparative Assessment of the Treatment of Type 2 Diabetes Mellitus

et al. 2002

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“…In this study, and others, another advantage of insulin therapy at low doses in combination with OHAs (especially metformin) was revealed: a reduced tendency for weight gain relative to insulin monotherapy. 17,19,20 Insulin in combination with OHAs: better glycaemic control than OHA monotherapy Many studies and widespread clinical practice have demonstrated that in a large number of patients with OHA failure, metabolic control is significantly improved with insulin treatment (either alone or in combination with OHAs). 19,21 -30 For example, in a study of 95 patients with a mean baseline HbA 1c of 11.0%, 34 reduced their HbA 1c to below 8.0% and 25 achieved levels below 7.5% ( Figure 2).…”

Section: Insulin Can Be Introduced Simply Into Combination Therapymentioning

confidence: 99%

Before oral agents fail: the case for starting insulin early

Marre

2002

Int J Obes

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The progressive nature of Type 2 diabetes presents a challenge over the choice and course of treatment. Strict metabolic control is recommended to reduce the risk of diabetic morbidity and premature mortality. Treatment usually occurs in a step-wise manner as the insulin secretory capacity of the beta-cells diminishes. There are a variety of oral hypoglycaemic agents (OHAs) to choose from but the efficacy of all is influenced by beta-cell function. Eventual progression to insulin therapy is inevitable after beta-cell failure and it is important that this is not delayed. Insulin in combination with OHAs can significantly improve glycaemic control and provide a 'bridge' from oral-only to insulin-only therapy. Combination therapy requires few injections and there is a reduced tendency for weight gain compared with multiple insulin injection regimens. After starting insulin, metabolic control may significantly improve in OHA-treated patients. It is therefore prudent to initiate insulin at an early stage in the course of Type 2 diabetes. In this context, the use of premixed insulin analogues in combination with OHAs allows effective postprandial glucose control, a twice-daily injection regimen and a short meal-injection interval.

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Comparison of Insulin With or Without Continuation of Oral Hypoglycemic Agents in the Treatment of Secondary Failure in NIDDM Patients

Cited by 97 publications

References 32 publications

Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

Sustained good glycaemic control in NIDDM patients by implementation of structured care in general practice: 2-year follow-up study

Comparative Assessment of the Treatment of Type 2 Diabetes Mellitus

Before oral agents fail: the case for starting insulin early

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