Effects of Insulin Versus Sulphonylurea on Beta-Cell Secretion in Recently Diagnosed Type 2 Diabetes Patients: A 6-year Follow-Up Study

Rev Diabet Stud. Fall 2010;7(3):225-32. doi: 10.1900/RDS.2010.7.225. Epub 2010 Nov 10.

Abstract

Background: Early insulin treatment is considered more beneficial than anti-diabetic medication with sulphonylureas, because the latter may exert negative effects on beta-cell function, while the former may help preserve it. In a previous study, we found that C-peptide response was increased in the insulin-treated group, whereas it was decreased in the glibenclamide group. However, it was not certain whether the advantage remained in the longer term.

Aim: In this study, we tested whether early insulin treatment is more beneficial than glibenclamide against a 6-year follow-up perspective.

Methods: We designed a randomized clinical trial in subjects with newly diagnosed type 2 diabetes. Glucagon stimulatory tests, measuring C-peptide and islet amyloid polypeptide (IAPP), were performed after 2, and 3, days of temporary insulin and glibenclamide withdrawal.

Results: 18 subjects initially randomized to glibenclamide, and 16 randomized to two daily injections of insulin, participated in end-of-study investigations. C-peptide response to glucagon deteriorated (p < 0.01 vs. baseline) in initially glibenclamide-treated patients (n = 18), but not in insulin-treated patients (p < 0.05 for difference between groups, after 2 days of treatment withdrawal). The IAPP response to glucagon declined in the glibenclamide group (p < 0.001), but not in insulin-treated subjects (p = 0.05 for difference between groups).

Conclusions: Early insulin treatment preserves beta-cell secretory function better than glibenclamide even in a 6-year perspective.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • C-Peptide / metabolism
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / metabolism
  • Female
  • Follow-Up Studies
  • Glucagon / metabolism
  • Glyburide / therapeutic use*
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Insulin / metabolism
  • Insulin / therapeutic use*
  • Insulin Secretion
  • Insulin-Secreting Cells / drug effects*
  • Insulin-Secreting Cells / metabolism
  • Male
  • Middle Aged

Substances

  • C-Peptide
  • Hypoglycemic Agents
  • Insulin
  • Glucagon
  • Glyburide