Diabetes Care, Vol 15, Issue 8 953-959, Copyright © 1992 by American Diabetes Association

ARTICLES

Is combination sulfonylurea and insulin therapy useful in NIDDM patients? A metaanalysis

JA Pugh, ML Wagner, J Sawyer, G Ramirez, M Tuley and SJ Friedberg
Audie L. Murphy Memorial Veterans Hospital, San Antonio, Texas 78284.

OBJECTIVE--To assess the efficacy of combination therapy with insulin and sulfonylurea in the treatment of NIDDM. RESEARCH DESIGN AND METHODS--Studies published between January 1966 and January 1991 were identified through a computerized Medline search and by hand searching the bibliographies of identified articles. We identified 17 eligible randomized, controlled trials of combination therapy in NIDDM. These trials had a minimum duration of 8 wk and at least one of three outcome measures (fasting glucose, HbA1, or C-peptide) with SD or SE of the mean reported to do metaanalysis. With standardized forms, three independent reviews abstracted measures of study quality and specific descriptive information about population, intervention, and outcome measurements. RESULTS--We calculated effect size and weighted mean changes of the three outcome measures for control and treatment groups. In the treatment group, the fasting plasma glucose decreased from a mean of 11.4 mM (206 mg/dl) at baseline to a mean of 9.16 mM (165 mg/dl) posttreatment, whereas the control group decreased from (11.3 to 10.8 mM) (204 to 194 mg/dl) (effect size 0.39, P less than 0.0001). For HbA1, the treatment group decreased from a baseline of 11.0 to 10.2% compared to 11.0 and 11.2% in the control group (effect size 0.43, P less than 0.0001). For fasting C-peptide, the treatment group increased from 0.49 to 0.58 nM (1.45 to 1.75 ng/ml) compared with 0.47 and 0.43 (1.42 and 1.30) for the control group (effect size 0.26, P less than 0.017). CONCLUSION--Combined insulin-sulfonylurea therapy leads to modest improvement in glycemic control compared with insulin therapy alone. With combined therapy, lower insulin doses may be used to achieve similar control. Obese patients with higher fasting C-peptides may be more likely to respond than others.
CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				N Brown Is it time to re-assess the role of gliclazide? Targeting insulin resistance in type 2 diabetes patients suboptimally controlled with insulin. Postgrad. Med. J., July 1, 2006; 82(969): 471 - 475. [Abstract] [Full Text] [PDF]

				S. Banarer, R. A. Apolito, and D. M. Nathan Initial Management of Glycemia in Type 2 Diabetes N. Engl. J. Med., February 20, 2003; 348(8): 760 - 761. [Full Text] [PDF]

				T. Richardson and D. Kerr Obesity in type 2 diabetes -- local experience in a district general hospital The British Journal of Diabetes & Vascular Disease, January 1, 2003; 3(1): 49 - 52. [Abstract] [PDF]

				H. Yki-Järvinen Combination Therapies With Insulin in Type 2 Diabetes Diabetes Care, April 1, 2001; 24(4): 758 - 767. [Full Text]

				L. Landstedt-Hallin, U. Adamson, and P.-E. Lins Oral Glibenclamide Suppresses Glucagon Secretion during Insulin-Induced Hypoglycemia in Patients with Type 2 Diabetes J. Clin. Endocrinol. Metab., September 1, 1999; 84(9): 3140 - 3145. [Abstract] [Full Text]

				H. Yki-Jarvinen, L. Ryysy, K. Nikkila, T. Tulokas, R. Vanamo, and M. Heikkila Comparison of Bedtime Insulin Regimens in Patients with Type 2 Diabetes Mellitus: A Randomized, Controlled Trial Ann Intern Med, March 2, 1999; 130(5): 389 - 396. [Abstract] [Full Text] [PDF]

				H. Yki-Jarvinen, L. Ryysy, M. Kauppila, E. Kujansuu, J. Lahti, T. Marjanen, L. Niskanen, S. Rajala, S. Salo, P. Seppala, et al. Effect of Obesity on the Response to Insulin Therapy in Noninsulin-Dependent Diabetes Mellitus J. Clin. Endocrinol. Metab., December 1, 1997; 82(12): 4037 - 4043. [Abstract] [Full Text] [PDF]