Glycaemic responsiveness to long‐term insulin plus sulphonylurea therapy as assessed by sulphonylurea withdrawal

Nybäck‐Nakell, Å.; Adamson, U.; Lins, Per‐Eric; Landstedt-Hallin, Lena

doi:10.1111/j.1464-5491.2007.02286.x

Cited by 18 publications

(7 citation statements)

References 28 publications

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“…According to the results of our study, showing that SUs are still able to stimulate the beta-cells despite being administered for several years and that glycemic control was worse after discontinuing them, SU should be therefore reasonably continued, with precautions against hypoglycemia, when the third oral glucose-lowering agent or insulin therapy is considered in T2DM patients with MFM-SUF. In addition, our study supports the results of previous studies in patients treated with combined insulin and SU demonstrating that discontinuation of SU resulted in worsening glycemic control,28–30 and the addition of SU in patients treated with all insulin regimens resulted in significant reductions in Hb A1c levels and decrease in insulin dosage by 20% 31…”

Section: Discussionsupporting

confidence: 89%

<p>Beta-cell function in type 2 diabetic patients who failed to maintain good glycemic status with a combination of maximum dosages of metformin and sulfonylurea</p>

Kunavisarut

Sriussadaporn

Lertwattanarak

2019

DMSO

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Background: The aim of this study was to investigate beta-cell function and examine whether sulfonylureas (SUs) are still useful in patients with type 2 diabetes (T2DM) who failed to maintain optimal glycemic control with a combination of maximum dosages of metformin and SU. Method: T2DM who had Hb A1c >8% during treatment with a combination of maximum dosages of metformin and SU were studied. After enrollment, the patients were assigned to continue maximum dosages of SU and metformin for 2 weeks and then underwent the first oral glucose tolerance test (OGTT), the Max-SU OGTT. After the Max-SU OGTT, SUs were discontinued for 4 weeks and the second OGTT, the Discont-SU OGTT, was performed. After the Discont-SU OGTT, the same SU was restarted at 25% of the maximum dosage (25%Max-SU). After taking 25%Max-SU for 4 weeks, the third OGTT, the 25%Max-SU OGTT, was performed. Metformin at the same dosage was continued throughout the study. Normal OGTT (NGT) subjects, matched for age and body mass index (BMI), were also studied. Results: There were 25 T2DM and 28 NGT subjects. There was no difference in age and BMI between the two groups. The beta-cell function during Max-SU was 0.1, which was higher than 0.06 during Discont-SU ( p <0.001) and also higher than 0.09 during 25%Max-SU ( p =0.269). The beta-cell function during 25%Max-SU was higher than during Discont-SU ( p <0.001). The beta-cell function of the NGT group was 0.34 and higher than during Max-SU ( p <0.001). Fasting capillary blood glucose (FCBG) levels during Discont-SU (14.2±3.7 mmol/L) were higher than during 25%Max-SU (12.3±3.4 mmol/L) and during Max-SU (10.3±2.4 mmol/L) ( p <0.05). In addition, the FCBG during Discont-SU was higher than that during 25%Max-SU ( p <0.05). Conclusion: In T2DM patients who failed to achieve glycemic control with a combination of maximum dosages of metformin and SU, the beta-cell function declined compared to NGT subjects. However, the beta-cells were still responsive to SUs, which play a significant role in glycemic control.

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Section: Discussionsupporting

confidence: 89%

<p>Beta-cell function in type 2 diabetic patients who failed to maintain good glycemic status with a combination of maximum dosages of metformin and sulfonylurea</p>

Kunavisarut

Sriussadaporn

Lertwattanarak

2019

DMSO

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“… 13 , 18 , 19 Previous studies have shown that withdrawing SUs from patients with a recent history of secondary SU failure requiring insulin resulted in deterioration of glycemic control. 7 , 8 Furthermore, adding glimepiride to insulin and metformin in patients with long-term type 2 DM was found to be effective in lowering HbA 1c and reducing the requirement for exogenous insulin. 20 Thus, our results provide further evidence that SUs remain effective in subjects with a long duration of diabetes.…”

Section: Discussionmentioning

confidence: 99%

Withdrawal of sulfonylureas from patients with type 2 diabetes receiving long-term sulfonylurea and insulin combination therapy results in deterioration of glycemic control: a randomized controlled trial

Srivanichakorn

Sriwijitkamol

Kongchoo

et al. 2015

DMSO

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BackgroundThe benefit of sulfonylureas (SUs) to patients with type 2 diabetes mellitus receiving long-term insulin treatment is unclear. This study evaluated glycemic control and beta-cell function after SU withdrawal in these patients.MethodsIn this 8-week randomized controlled study, patients with type 2 diabetes who had been treated with insulin for at least 3 years plus moderate to high doses of SUs were randomly assigned to withdrawal (n=16) or continuation (n=16) of SUs. Clinical characteristics, glycemic control, hypoglycemic events, and insulin secretion, including homeostasis model assessment of beta-cell function (HOMA-B) score, C-peptide concentration, and Matsuda index, were evaluated at baseline and after 2 and 8 weeks.ResultsThirty patients (16 in the SU withdrawal group and 14 in the SU continuation group) completed the study. Median duration of diabetes was 17 (range 5–40) years. Baseline clinical characteristics, glycemic control, and HOMA-B were similar in the two groups, but the mean fasting C-peptide concentration was higher in the SU withdrawal group. After 8 weeks, the SU withdrawal group showed a significant increase in mean glycosylated hemoglobin levels from 7.8%±0.5% (62±5 mmol/mol) to 8.6%±1.2% (71±13 mmol/mol; P=0.002), whereas the SU continuation group showed a slight but not significant increase from 7.7%±0.5% (61±5 mmol/mol) to 7.9%±1.2% (63±13 mmol/mol; P=0.37). Insulin secretion, as measured by C-peptide and HOMA-B, decreased by 18% and 36%, respectively, in the SU withdrawal group. Hypoglycemic events were significantly more frequent in the SU continuation group whereas body weight did not change significantly in either group.ConclusionWithdrawal of SU from patients with type 2 diabetes receiving long-term combination treatment with SU and insulin resulted in deterioration of glycemic control and insulin secretion.

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“…Previous trials of basal insulin initiation, in which greater HbA1c reductions were reported, mostly retained pre‐existing OAD doses . Nybäck‐Nakell showed that many patients with T2D receiving insulin but discontinuing SUs experienced a rapid decline in glycaemic control. In a randomized controlled trial in insulin‐naïve patients comparing glargine and NPH insulin, there was no difference in SMBG profiles (or HbA1c), even though NPH is clearly a shorter acting insulin than glargine, but on the other hand the OADs were continued.…”

Section: Discussionmentioning

confidence: 99%

Once‐daily initiation of basal insulin as add‐on to metformin: a 26‐week, randomized, treat‐to‐target trial comparing insulin detemir with insulin glargine in patients with type 2 diabetes

Meneghini

Kesavadev

Demissie

et al. 2013

Diabetes Obesity Metabolism

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Aims: This study assessed the efficacy and safety of once-daily insulin initiation using insulin detemir (detemir) or insulin glargine (glargine) added to existing metformin in type 2 diabetes (T2D). Methods:This 26-week, multinational, randomized, treat-to-target trial involved 457 insulin-naïve adults with T2D (HbA1c 7-9%). Detemir or glargine was added to current metformin therapy [any second oral antidiabetic drug (OAD) discontinued] and titrated to a target fasting plasma glucose (FPG) ≤90 mg/dl (≤5.0 mmol/l). Primary efficacy endpoint was change in HbA1c.Results: Mean (s.d.) HbA1c decreased with detemir and glargine by 0.48 and 0.74%-points, respectively, to 7.48% (0.91%) and 7.13% (0.72%) [estimated between-treatment difference, 0.30 (95% CI: 0.14-0.46)]. Non-inferiority for detemir at the a priori level of 0.4%-points was not established. The proportions of patients reaching HbA1c ≤ 7% at 26 weeks were 38% and 53% (p = 0.026) with detemir and glargine, respectively. FPG decreased ∼43.2 mg/dl (∼2.4 mmol/l) in both groups [non-significant (NS)]. Treatment satisfaction was good for both insulins. Hypoglycaemia, which occurred infrequently, was observed less with detemir than glargine [rate ratio 0.73 (95% CI 0.54-0.98)]. The proportions of patients reaching HbA1c ≤ 7% without hypoglycaemia in the detemir and glargine groups were 32% and 38% (NS), respectively. Weight decreased with detemir [−0.49 (3.3) kg] and increased with glargine [+1.0 (3.1) kg] (95% CI for difference: −2.17 to −0.89 kg). Conclusion:While both detemir and glargine, when added to metformin therapy, improved glycaemic control, glargine resulted in greater reductions in HbA1c, while detemir demonstrated less weight gain and hypoglycaemia.

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Glycaemic responsiveness to long‐term insulin plus sulphonylurea therapy as assessed by sulphonylurea withdrawal

Abstract: In 80% of this group of patients, glycaemic control deteriorated after SU withdrawal despite long duration of SU treatment.

Cited by 18 publications

References 28 publications

<p>Beta-cell function in type 2 diabetic patients who failed to maintain good glycemic status with a combination of maximum dosages of metformin and sulfonylurea</p>

<p>Beta-cell function in type 2 diabetic patients who failed to maintain good glycemic status with a combination of maximum dosages of metformin and sulfonylurea</p>

Withdrawal of sulfonylureas from patients with type 2 diabetes receiving long-term sulfonylurea and insulin combination therapy results in deterioration of glycemic control: a randomized controlled trial

Once‐daily initiation of basal insulin as add‐on to metformin: a 26‐week, randomized, treat‐to‐target trial comparing insulin detemir with insulin glargine in patients with type 2 diabetes

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