Prevention of weight gain in type 2 diabetes requiring insulin treatment

  1. H. De Boer1,*,
  2. M. Jansen2,
  3. J. Koerts3,
  4. L. Verschoor1

Article first published online: 26 JAN 2004

DOI: 10.1111/j.1463-1326.2004.00322.x

Issue

Diabetes, Obesity and Metabolism

Diabetes, Obesity and Metabolism

Volume 6, Issue 2, pages 114–119, March 2004

Additional Information

How to Cite

De Boer, H., Jansen, M., Koerts, J. and Verschoor, L. (2004), Prevention of weight gain in type 2 diabetes requiring insulin treatment. Diabetes, Obesity and Metabolism, 6: 114–119. doi: 10.1111/j.1463-1326.2004.00322.x

Author Information

  1. 1

    Department of Internal Medicine, Ziekenhuis Rijnstate Arnhem, Arnhem, The Netherlands

  2. 2

    Department of Pharmacology, Ziekenhuis Rijnstate Arnhem, Arnhem, The Netherlands

  3. 3

    Department of Clinical Chemistry, Ziekenhuis Rijnstate Arnhem, Arnhem, The Netherlands

* *H. de Boer, MD, PhD, Ziekenhuis Rijnstate Arnhem, Wagnerlaan 55, 6800 TA Arnhem, The Netherlands. E-mail: hdeboer@alysis.nl

Publication History

  1. Issue published online: 26 JAN 2004
  2. Article first published online: 26 JAN 2004
  3. Received 1 August 2003; revised version accepted 26 September 2003

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Keywords:

  • diabetes mellitus type 2;
  • insulin aspart;
  • insulin treatment;
  • rapid-acting insulin analogues;
  • secondary failure;
  • weight gain;
  • glimepiride

Background: Patients with type 2 diabetes who are failing on oral agents will generally gain a large amount of body fat when switched to insulin treatment. This adverse effect may be related to chronic hyperinsulinism induced by long-acting insulin compounds.

Aim: To test the concept that regain of glycaemic control can be achieved without causing weight gain, using a regimen free of long-acting insulin.

Methods: In a 3-month open-label pilot study including 25 patients with moderate overweight and secondary failure, we investigated whether nocturnal glycaemic control could be achieved with glimepiride administered at 20:00 hours. The starting dose was 1–2 mg, with subsequent titration up to a maximum of 6 mg. Rapid-acting insulin analogues were used three times daily to regain postprandial glucose control.

Results: Glycaemic control at 3 months was established with glimepiride in a dose of 4.4 ± 0.3 mg/day (mean ± standard error of the mean), and a total daily insulin dose of 24.1 ± 2.6 IU. Fasting glucose levels decreased from 12.7 ± 0.6 mmol/l to 8.1 ± 0.3 mmol/l (p < 0.001), and target levels were reached in 14 of 25 patients (56%). Mean HbA1c decreased from 10.5 ± 0.4 to 7.7 ± 0.2% (p < 0.001). Symptomatic nocturnal hypoglycaemia was not reported. Body weight did not change (85.7 ± 3.6 kg vs. 85.7 ± 3.3 kg, p = 0.99).

Conclusion: The data suggest that this new approach may be useful in about 50% of type 2 diabetes patients presenting with failure on maximal oral treatment.

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