Effects of insulin vs. glibenclamide in recently diagnosed patients with type 2 diabetes: a 4-year follow-up

  1. M. Alvarsson1,*,
  2. G. Sundkvist2,3,
  3. I. Lager4,
  4. K. Berntorp2,3,
  5. E. Fernqvist-Forbes5,
  6. L. Steen6,
  7. T. Örn7,
  8. M. A. Holberg8,
  9. N. Kirksæther8,
  10. V. Grill1

Article first published online: 29 MAR 2007

DOI: 10.1111/j.1463-1326.2007.00719.x

Issue

Diabetes, Obesity and Metabolism

Diabetes, Obesity and Metabolism

Volume 10, Issue 5, pages 421–429, May 2008

Additional Information

How to Cite

Alvarsson, M., Sundkvist, G., Lager, I., Berntorp, K., Fernqvist-Forbes, E., Steen, L., Örn, T., Holberg, M. A., Kirksæther, N. and Grill, V. (2008), Effects of insulin vs. glibenclamide in recently diagnosed patients with type 2 diabetes: a 4-year follow-up. Diabetes, Obesity and Metabolism, 10: 421–429. doi: 10.1111/j.1463-1326.2007.00719.x

Author Information

  1. 1

    Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden

  2. 2

    Department of Clinical Sciences, Lund University, Malmö, Sweden

  3. 3

    Department of Endocrinology, Malmö University Hospital, Malmö, Sweden

  4. 4

    Department of Medicine, Kristianstad Hospital, Kristianstad, Sweden

  5. 5

    Department of Medicine, Visby Hospital, Visby, Sweden

  6. 6

    Department of Medicine, Mälarsjukhuset, Eskilstuna, Sweden

  7. 7

    Department of Medicine, Blekingesjukhuset, Karlskrona, Sweden

  8. 8

    Institute of Cancer Research and Molecular Biology, Norwegian University of Science and Technology, University Hospital of Trondheim, Trondheim, Norway

*Michael Alvarsson, Department of Endocrinology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden. E-mail: michael.alvarsson@karolinska.se

Publication History

  1. Issue published online: 29 MAR 2007
  2. Article first published online: 29 MAR 2007
  3. Received 20 November 2006; returned for revision 6 February 2007; revised version accepted 7 February 2007

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Keywords:

  • beta-cell protection;
  • diabetes mellitus;
  • glibenclamide;
  • insulin;
  • insulin secretion

Aim:  To compare effects of early insulin vs. glibenclamide treatment on beta-cell function, metabolic control and quality of life (QL) in recently diagnosed patients with type 2 diabetes.

Methods:  Forty-nine patients with type 2 diabetes diagnosed 0–2 years before inclusion were randomized to two daily injections of premixed 30% soluble and 70% NPH insulin or glibenclamide at six diabetic clinics in Sweden. C-peptide–glucagon tests were performed yearly after 3 days of withdrawal of treatment.

Results:  Thirty-four patients completed 4 years of study. Daily dose of insulin was increased from 20.4 ± 1.8 U at year 1 to 26.1 ± 2.9 U at year 4 (p = 0.005). Glibenclamide dosage increased from 2.7 ± 0.4 mg at year 1 to 4.5 ± 0.8 mg at year 4 (p = 0.02). Weight increased more in insulin than in glibenclamide treated (+4.4 ± 0.8 vs. +0.3 ± 1.0 kg, p < 0.005). Following short-term withdrawal of treatment, the C-peptide responses to glucagon were significantly higher in the insulin vs. glibenclamide group at years 1 (p < 0.01) and 2 (p < 0.02). HbA1c improved identical during the first year but thereafter deteriorated in the glibenclamide group (p < 0.005 for difference at year 4). Ratios of proinsulin to insulin were higher during treatment in glibenclamide- vs. insulin-treated patients after year 2. QL after 4 years as measured by the MOS 36-item Short-Form Health Survey (SF-36) form was not significantly altered.

Conclusions:  In a 4-year perspective, beta-cell function deteriorated in both groups. However, deterioration occurred faster in the glibenclamide group, indicating that alleviating demands on secretion by insulin treatment is beneficial.

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