Reduction of Sulfonylurea with the Initiation of Basal Insulin in Patients with Inadequately Controlled Type 2 Diabetes Mellitus Undergoing Long-Term Sulfonylurea-Based Treatment.
10.4093/dmj.2016.40.6.454
- Author:
Yeoree YANG
1
;
Jeong Ah SHIN
;
Hae Kyung YANG
;
Seung Hwan LEE
;
Seung Hyun KO
;
Yu Bae AHN
;
Kun Ho YOON
;
Jae Hyoung CHO
Author Information
1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. drhopper@catholic.ac.kr
- Publication Type:Randomized Controlled Trial ; Original Article
- Keywords:
Basal insulin;
Beta-cell;
Diabetes mellitus, type 2;
Recovery;
Sulfonylurea
- MeSH:
Diabetes Mellitus, Type 2*;
Follow-Up Studies;
Glucose Tolerance Test;
Hemoglobin A, Glycosylated;
Humans;
Insulin*;
Insulin, Long-Acting;
Triglycerides;
Weight Gain
- From:Diabetes & Metabolism Journal
2016;40(6):454-462
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: There were a limited number of studies about β-cell function after insulin initiation in patients exposed to long durations of sulfonylurea treatment. In this study, we aimed to evaluate the recovery of β-cell function and the efficacy of concurrent sulfonylurea use after the start of long-acting insulin. METHODS: In this randomized controlled study, patients with type 2 diabetes mellitus (T2DM), receiving sulfonylurea for at least 2 years with glycosylated hemoglobin (HbA1c) >7%, were randomly assigned to two groups: sulfonylurea maintenance (SM) and sulfonylurea reduction (SR). Following a 75-g oral glucose tolerance test (OGTT), we administered long-acting basal insulin to the two groups. After a 6-month follow-up, we repeated the OGTT. RESULTS: Among 69 enrolled patients, 57 completed the study and were analyzed: 31 in the SM and 26 in the SR group. At baseline, there was no significant difference except for the longer duration of diabetes and lower triglycerides in the SR group. After 6 months, the HbA1c was similarly reduced in both groups, but there was little difference in the insulin dose. In addition, insulin secretion during OGTT was significantly increased by 20% to 30% in both groups. A significant weight gain was observed in the SM group only. The insulinogenic index was more significantly improved in the SR group. CONCLUSION: Long-acting basal insulin replacement could improve the glycemic status and restore β-cell function in the T2DM patients undergoing sulfonylurea-based treatment, irrespective of the sulfonylurea dose reduction. The dose reduction of the concurrent sulfonylurea might be beneficial with regard to weight grain.
