Beneficial Effects of Insulin Versus Sulphonylurea on Insulin Secretion and Metabolic Control in Recently Diagnosed Type 2 Diabetic Patients

  1. Michael Alvarsson, MD, PHD1,
  2. Göran Sundkvist, MD, PHD2,
  3. Ibe Lager, MD, PHD3,
  4. Marianne Henricsson, MD, PHD4,
  5. Kerstin Berntorp, MD, PHD2,
  6. Eva Fernqvist-Forbes, MD, PHD5,
  7. Lars Steen, MD6,
  8. Gunilla Westermark, MD, PHD7,
  9. Per Westermark, MD, PHD7,
  10. Thomas Örn, MD8 and
  11. Valdemar Grill, MD, PHD1
  1. 1Department of Endocrinology and Diabetology, Karolinska Hospital, Stockholm, Sweden
  2. 2Department of Endocrinology, Malmö University Hospital, Malmö, Sweden
  3. 3Department of Medicine, Kristianstad Hospital, Kristianstad, Sweden
  4. 4Department of Ophthalmology, Helsingborg Hospital, Helsingborg, Sweden
  5. 5Department of Medicine, Visby Hospital, Visby, Sweden
  6. 5Department of Medicine, Mälarsjukhuset, Eskilstuna, Sweden
  7. 6Division of Cell Biology, Faculty of Health Sciences, Linköping, Sweden
  8. 7Department of Medicine, Blekingesjukhuset, Karlskrona, Sweden
  1. Address correspondence and reprint requests to Michael Alvarsson, Department of Endocrinology and Diabetology, Karolinska Hospital, SE-171 76 Stockholm, Sweden. E-mail: michael.alvarsson{at}ks.se

Abstract

OBJECTIVE—To evaluate whether treatment with insulin in recently diagnosed type 2 diabetes is advantageous compared with glibenclamide treatment.

RESEARCH DESIGN AND METHODS—β-Cell function, glycemic control, and quality of life were monitored over 2 years in 39 patients with islet cell antibody-negative type 2 diabetes diagnosed 0–2 years before inclusion in a Swedish multicenter randomized clinical trial. Patients were randomized to either two daily injections of premixed 30% soluble and 70% NPH insulin or glibenclamide (3.5–10.5 mg daily). C-peptide-glucagon tests were performed yearly in duplicate after 2–3 days of temporary withdrawal of treatment.

RESULTS—After 1 year the glucagon-stimulated C-peptide response was increased in the insulin-treated group by 0.14 ± 0.08 nmol/l, whereas it was decreased by 0.12 ± 0.08 nmol/l in the glibenclamide group, P < 0.02 for difference between groups. After 2 years, fasting insulin levels were higher after treatment withdrawal in the insulin-treated versus the glibenclamide-treated group (P = 0.02). HbA1c levels decreased significantly during the first year in both groups; however, at the end of the second year, HbA1c had deteriorated in the glibenclamide group (P < 0.01), but not in the insulin-treated group. The difference in evolution of HbA1c during the second year was significant between groups, P < 0.02. A questionnaire indicated no difference in well-being related to treatment.

CONCLUSIONS—Early insulin versus glibenclamide treatment in type 2 diabetes temporarily prolongs endogenous insulin secretion and promotes better metabolic control.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted May 4, 2003.
    • Received January 31, 2003.
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  1. doi: 10.2337/diacare.26.8.2231 Diabetes Care August 2003 vol. 26 no. 8 2231-2237
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