U.K. Prospective Diabetes Study: II. Reduction in HbA1c with Basal Insulin Supplement, Sulfonylurea, or Biguanide Therapy in Maturity-onset Diabetes

Abstract

Newly presenting maturity-onset diabetic subjects were put on diet and if, after 3-4 mo, their fasting plasma glucose continued >6 mmol/L, they were randomized to three therapies: (1) continuing diet alone, (2) with additional sulfonylurea, or (3) with additional basal insulin supplement provided by ultralente insulin. Obese patients were also randomized to metformin therapy. The aim was to lower the fasting plasma glucose to <6 mmol/L and the degree to which this reduced the hemoglobin A 1c (HbA 1c ) concentration was studied in 195 patients over 1 yr. Sulfonylurea and insulin similarly reduced (P < 0.001) the fasting plasma glucose from 8.3 ± 1.9 to 6.7 ± 1 . 3 mmol/L (mean ± 1 SD) and 8.6 ± 2.2 to 6.8 ± 1 . 4 mmol/L, respectively. This was accompanied by a significant reduction (P < 0.001) of the HbA 1c to the high normal range, from 9.1 ± 2.1% to 7.8 ± 1.2%, and from 9.1 ± 1.9% to 8.1 ± 1.3%, respectively, both values at 1 yr being significantly (P < 0.05) lower than in patients randomized to diet alone. Patients randomized to diet alone had little change in