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Combined insulin and sulfonylurea therapy in non-insulin-dependent diabetics with secondary failure to oral drugs: a one year follow-up.

We studied the influence of chronic sulfonylurea treatment on glucose metabolism and beta-cell secretory activity in diabetic patients requiring insulin after secondary failure to oral drugs. Thirty diabetics were allocated at random into two groups, each consisting of 15 subjects: group A continued insulin treatment, while group B received combined insulin plus sulfonylurea. Daily doses of the sulfonylurea gliclazide ranged from 40 to 240 mg, and dose adjustment was made on the basis of periodic monthly control. This treatment (12 months) caused a significant improvement of both diurnal glucose profile and HbA1 levels; the beta-cell secretory response to 1 mg glucagon was significantly increased at the end of the study. There was on average a 40% reduction of the daily insulin dose in the diabetics receiving combined treatment. None of these improvements were seen in the control group receiving only insulin for the same period of time. We suggest that combining a sulfonylurea with insulin can be useful in insulin-requiring type-2 diabetics who still secrete some endogenous insulin.