Early Insulin: An Important Therapeutic Strategy

Diabetes Care (Impact Factor: 8.42). 02/2005; 28(1):220-1. DOI: 10.2337/diacare.28.1.220
Source: PubMed
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    • "According to 2007 ADA guideline for diabetes, it is recommended to use insulin on type 2 diabetic patient if poorly controlled with baseline HbA1c over 7%. Now, using insulin as early as possible nearly becomes the optimal treatment to protect the remained islet function [1] [2] [3] [4]. However many patients hesitate to accept this strategy for the incident of hypoglycemia as well as its inconvenience, and also concern of weight gain. "
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    ABSTRACT: To compare the compliance and efficacy among three treatment modalities in patients of type 2 diabetes with fairly good islet function. This 38-month open, randomized, prospective study enrolled 536 subjects (HbA1c 9.4+/-0.8%). Patients were divided into three groups including continual insulin injection (I), continual secretagogue administration (S) and alternation of two-month insulin injection and four-month secretagogue treatment (A). At baseline and every three months, HbA1c was measured and a standard bread meal test (100g) was performed. HbA1c were better controlled in both groups I and A than in S (6.9+/-0.3%, 6.8+/-0.3% vs. 7.6+/-0.5%). Hypoglycemia incidence was much lower in group A than that in I (0.8 times/patient/month vs. 2.4 times/patient/month) also with less weight gain (1.6 kg vs. 2.8 kg/patient/year). From the standard bread meal test, patients in group A got the greatest increment of 2-h C-peptide. Inquiry from all subjects showed that alternate strategy was welcomed by most of them considering for convenience and efficacy. Alternate insulin-secretagogue treatment can effectively reduce HbA1c and help to improve islet function with reduced risk of hypoglycemia and weight gain under good compliance.
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    ABSTRACT: Sulfonylurea compounds were the first available oral antidiabetic agents and they remain an important tool in our quest for optimal glycemic control. The more recent introduction of meglitinides offers an approach to short-term insulin release with minimal hypoglycemic risk during fasting periods. Published trials suggest that individuals with a hemoglobin A(1c) above 8.5% are unlikely to reach currently recommended targets (6.5% to 7%) without the use of one of these insulin secretagogues. Starting and probable maximally effective doses for glimepiride are 1 to 2 mg initially and 4 mg thereafter. For glyburide and glipizide, these are 2.5 to 5 mg initially, and 10 mg effective at a maximum. The large majority of the effect can be seen within a week, making them very attractive when rapid lowering of glucose is needed. An understanding of the principles will facilitate more effective use of initial and combination therapy.
    No preview · Article · Nov 2005 · Current Diabetes Reports
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