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

Abstract

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.

<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>

“…A better model for evaluation of beta-cell function to correct for the confounding effects of glucotoxicity, such as inducing normoglycemia by adding insulin and subsequently reassessing beta-cell function, could be performed. However, a randomized controlled study conducted by our group (Srivanichakorn et al), in T2DM patients who achieved optimal glycemic control during long-term treatment with combined SU and insulin, showed that withdrawal of SU resulted in worsening of glycemic status 29. The findings from Srivanichakorn et al and the present study confirm that SU still plays a significant role in glycemic control in both hyperglycemic and optimal glycemic states.…”

Interprofessional Continuous Glucose Monitoring for Underserved Adults with Type 2 Diabetes on Insulin or Secretagogues

“…15 Abrupt discontinuation of insulin or secretagogues without monitoring could inadvertently result in hyperglycemia. 16,17 We also felt professional CGM was beneficial for individualizing monitoring plans. Instead of depending on subjective feedback, clinical results were used to guide recommendations for longterm CGM use.…”

Impact of Initial eGlycemic Management System Dosing Strategy on Time to Target Blood Glucose Range

“…15 Deterioration of glycemic control is reported in multiple studies when sulfonylureas are withdrawn from therapy due to impacted insulin secretion. [16][17][18] As such, the multiplier group may have been disproportionately impacted by this factor due to the slightly greater baseline use of sulfonylureas. Accurate medication reconciliation and critical evaluation of anti-hyperglycemic medications prior to admission, including sulfonylureas, and appropriate adjustment of insulin in response would be beneficial to improve inpatient glycemic control.…”