Diabetes Mellitus, Type 2/drug therapy/physiopathology; Drug Therapy, Combination; Humans; Hypoglycemic Agents/therapeutic use; Insulin/therapeutic use; Sulfonylurea Compounds/therapeutic use
Abstract :
[en] According to the modern pathophysiological understanding of type 2 diabetes and the mechanisms of sulfonylurea action, combined insulin-sulfonylurea therapy appears to be an interesting alternative for treating diabetic patients with secondary failure to sulfonylureas. From its revival in the early 1980s, combination therapy has been shown to have a positive effect on blood glucose control although initially published clinical studies, generally open and uncontrolled, have been widely criticized. Several recent well-designed studies confirmed these favorable results, with better glucose profiles and/or decreased insulin needs, which were shown to persist after 1 year or more. Most of the studies investigating the mechanism of action indicate that the effect is mainly due to stimulation of the residual insulin secretion with minimal or no effect on insulin sensitivity. The risk of hypoglycemic episodes is rather small when insulin doses are adapted at the beginning of the combined therapy. Effects on lipid metabolism are minimal and controversial. Thus, insulin-sulfonylurea treatment may be a safe and effective solution in type 2 diabetic patients with secondary failure to sulfonylureas, particularly in those with significant residual endogenous insulin secretion. The additional cost of such combined therapy should be weighed against the potential advantages of better metabolic control.
Disciplines :
Endocrinology, metabolism & nutrition
Author, co-author :
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Lefebvre, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Diabétologie,nutrition, maladies métaboliques
Language :
English
Title :
Insulin versus insulin plus sulfonylureas in type 2 diabetic patients with secondary failure to sulfonylureas.
Fabrykant (1957) Favorable effects of supplemental orinase in insulin-treated labile diabetes. Metabolism 6:509-517.
Friedlander (1957) Use of tolbutamide in insulin resistant diabetes: report of a case. N. Engl. J. Med. 257:11-14.
Lazarus, Volk (1959) Physiological basis of the effectiveness of combined insulin-tolbutamide therapy in stable diabetes. Ann. N.Y. Acad. Sci. 82:590-602.
Kyllästinen (1983) Sulphonylurea in combination with insulin therapy: does it make sense?. Ann. Clin. Res. 15:29-32.
Scheen, Luyckx, Castillo, Lefèbvre (1985) Rôle thérapeutique des effets extra-pancréatiques des sulfamidés. Méd. Hyg. 43:3816-3820.
Charbonnel, Murat, du Rostu, Krempf (1985) Y a-t-il une place pour les hypoglycémiants oraux dans le traitement du diabète sous insuline (diabète insulino-dépendant et diabète insulino-nécessitant)?. Rev. Franç. Endocrinol. Clin. 26:139-152.
DeFronzo, Ferrannini, Koïvisto (1983) New concepts in the pathogenesis and treatment of non insulin-dependent diabetes mellitus. Am. J. Med. 74:52-81.
Melander (1987) Clinical pharmacology of sulfonylureas. Metabolism 36:12-16.
Standl, Vague (1987) Hyperinsulinemia as a possible risk factor of macrovascular disease in diabetes mellitus. Proceedings of an international workshop held in Saint-Paul-de-Vence (Nice/France), January 29–30 , Diab. Metab. 13, 3bis; 277-394.
Groop, Harno, Tolppanen (1984) The combination of insulin and sulphonylurea in the treatment of secondary drug failure in patients with type II diabetes. Acta Endocrinol. 106:97-101.
Mauerhoff, Ketelslegers, Lambert (1986) Effect of glibenclamide in insulin-treated diabetic patients with a residual insulin secretion. Diab. Metab. 12:34-38.
Schade, Mitchell, Griego (1987) Addition of sulfonylurea to insulin treatment in poorly controlled type II diabetes. J. Am. Med. Ass. 257:2441-2445.
Stenman, Groop, Saloranta, Tötterman, Fyhrqvist, Groop (1988) Effects of the combination of insulin and glibenclamide in type 2 (non-insulin-dependent) diabetic patients with secondary failure to oral hypoglycaemic agents. Diabetologia 31:206-213.
Quatraro, Consoli, Ceriello, Giugliano (1986) Combined insulin and sulfonylurea therapy in noninsulin-dependent diabetics with secondary failure to oral drugs: a one year follow-up. Diab. Metab. 12:315-318.
Kitabehi, Soria, Radparvar, Lawson-Grant (1987) Combined therapy of insulin and tolazamide decreases insulin requirement and serum triglycerides in obese patients with noninsulin-dependent diabetes mellitus. Am. J. Med. Sci. 294:10-14.
Longnecker, Elsenhans, Leiman, Owen, Boden (1986) Insulin and a sulfonylurea agent in non-insulin-dependent diabetes mellitus. Arch. Intern. Med. 146:673-676.
Reich, Abraira, Lawrence (1987) Combined glyburide and insulin therapy in type II diabetes. Diab. Res. 6:99-104.
Lardinois, Liu, Reaven (1985) Glyburide in non-insulin-dependent diabetes. Its therapeutic effect in patients with disease poorly controlled by insulin alone. Arch. Intern. Med. 145:1028-1032.
Allen, Feinglos, Lebovitz (1985) Treatment of poorly regulated non-insulin-dependent diabetes mellitus with combination insulin-sulfonylurea. Arch. Intern. Med. 145:1900-1903.
Groop, Harno, Nikkila, Pelkonen, Tolppanen (1985) Transient effect of the combination of insulin and sulfonylurea (glibenclamide) on glycemic control in non-insulin dependent diabetics poorly controlled with insulin alone. Acta Med. Scand. 217:33-39.
Gutniak, Karlander, Efendic (1987) Glyburide decreases insulin requirement, increases B-cell response to mixed meal, and does not affect insulin sensitivity: effect of short- and long-term combined treatment in secondary failure to sulfonylurea. Diabetes Care 10:545-554.
Simonson, Delprato, Castellino, Groop, DeFronzo (1987) Effect of glyburide on glycemic control, insulin requirement, and glucose metabolism in insulin-treated diabetic patients. Diabetes 36:136-146.
Castillo, Scheen, Paolisso, Lefèbvre (1987) The addition of glipizide to insulin therapy in type-II diabetic patients with secondary failure to sulfonylureas is useful only in the presence of a significant residual insulin secretion. Acta Endocrinol. 116:364-372.
Osei, O'Dorisio, Falko (1984) Concomitant insulin and sulfonylurea therapy in patients with type II diabetes. Effects on glucoregulation and lipid metabolism. Am. J. Med. 77:1002-1009.
Reaven, Fraze, Chen, Hollenbeck, Chen (1987) Evaluation of the clinical utility of combined insulin and sulfonylurea therapy for patients with non-insulin-dependent diabetes mellitus. Presented as a Scientific Exhibit at the 39th Annual Scientific Assembly of the American Academy of Family Physicians, San Francisco, CA, September 14–17; .
Scheen, Castillo, Lefèbvre (1988) Decreased or increased insulin metabolism after glipizide in type II diabetes?. Diabetes Care 11:687-689.
Osei, Falko (1985) Serum C-peptide levels determine glycemic responses in type II diabetic patients treated with combined insulin and sulfonylurea agent. Am. J. Med. Sci. 289:148-153.
Rizza (1985) Combined sulfonylurea and insulin therapy in insulin-dependent diabetes: research or clinical practice?. Diabetes Care 8:511-514.
Kabadi, Birkenholz (1988) Improved metabolic control in insulin-dependent diabetes mellitus with insulin and tolazamide. Arch. Intern. Med. 148:1745-1749.