Document Detail


Beginning insulin treatment of obese patients with evening 70/30 insulin plus glimepiride versus insulin alone. Glimepiride Combination Group.
MedLine Citation:
PMID:  9653594     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study tested a simple algorithm for beginning insulin for obese patients with type 2 diabetes after sulfonylurea failure, comparing suppertime 70/30 insulin plus continued glimepiride with insulin alone. RESEARCH DESIGN AND METHODS: This was a multicenter ambulatory randomized double-masked parallel comparison. There were 208 subjects with secondary failure to sulfonylureas who took glimepiride titrated to 8 mg b.i.d. for 8 weeks; 145 subjects with fasting plasma glucose (FPG) 180-300 mg/dl (10-16.7 mmol/l) on this treatment were randomized to placebo plus insulin (PI) or glimepiride plus insulin (GI) for 24 weeks. A dosage of 70/30 insulin before supper was titrated, seeking fasting capillary blood glucose (FBG) 120 mg/dl (6.7 mmol/l), equivalent to FPG 140 mg/dl (7.8 mmol/l). Outcome measures included FPG, HbA1c, insulin dosage, weight, serum insulin and lipids, and adverse events. RESULTS: FPG and HbA1c were equivalent at baseline: 261 vs. 250 mg/dl (14.5 vs. 13.9 mmol/l), and 9.9 vs. 9.7%. At 24 weeks, the FPG target was achieved in both groups (136 vs. 138 mg/dl, 7.6 vs. 7.6 mmol/l), and HbA1c values were equal (7.7 vs. 7.6%). However, with GI, control improved faster and fewer subjects dropped out (3 vs. 15%, P < 0.01), and less insulin was needed (49 vs. 78 U/d, P < 0.001). The outcomes were alike in other respects. No subject had severe hypoglycemia. CONCLUSIONS: Injection of 70/30 insulin before supper safely restored glycemic control of type 2 diabetes not controlled by glimepiride alone. Control was restored more rapidly and with less injected insulin when glimepiride was continued.
Authors:
M C Riddle; J Schneider
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Diabetes care     Volume:  21     ISSN:  0149-5992     ISO Abbreviation:  Diabetes Care     Publication Date:  1998 Jul 
Date Detail:
Created Date:  1998-09-21     Completed Date:  1998-09-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7805975     Medline TA:  Diabetes Care     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1052-7     Citation Subset:  IM    
Affiliation:
Section of Diabetes L-345, Oregon Health Sciences University, Portland 97201, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Glucose / drug effects,  metabolism
C-Peptide / blood,  drug effects
Cholesterol, HDL / blood,  drug effects
Cholesterol, LDL / blood,  drug effects
Diabetes Mellitus / drug therapy*
Diabetes Mellitus, Type 2 / drug therapy
Dose-Response Relationship, Drug
Double-Blind Method
Drug Administration Schedule
Drug Therapy, Combination
Fasting
Female
Hemoglobin A, Glycosylated / drug effects,  metabolism
Humans
Hypoglycemia / chemically induced
Hypoglycemic Agents / adverse effects,  therapeutic use*
Insulin / adverse effects,  blood,  therapeutic use*
Male
Middle Aged
Obesity*
Patient Dropouts
Sulfonylurea Compounds / adverse effects,  therapeutic use*
Treatment Outcome
Triglycerides / blood
Chemical
Reg. No./Substance:
0/Blood Glucose; 0/C-Peptide; 0/Cholesterol, HDL; 0/Cholesterol, LDL; 0/Hemoglobin A, Glycosylated; 0/Hypoglycemic Agents; 0/Sulfonylurea Compounds; 0/Triglycerides; 11061-68-0/Insulin; 93479-97-1/glimepiride

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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