Therapies for Type 2 Diabetes
The united kingdom prospective Diabetes Study initially involved 4075 newly diagnosed Type 2 diabetics who underwent a three-month run-in period of diet alone. At the conclusion of this period, 458 patients continued to have either substantial hyperglycemia (FBS > 15 mmol/L) or symptoms of hyperglycemia and were randomized to receive insulin therapy (typical dose 36 U/d), sulfonylurea (typical dose chlorpropamide 500 mg/d or glyburide 20 mg/d), or metformin (typical dose 2550 mg/d).
Patients receiving insulin gained more weight (9.9 kg) over six years than those receiving sulfonylureas (3.7 kg) or metformin (trend toward decreased body weight, 1.3 kg). Overall, the decreases in hemoglobin A1C were similar in all therapeutic groups, despite the fact that insulin therapy was associated with the lowest fasting insulin levels.
Over the course of six years, approximately 60% of both sulfonylurea and metformin recipients failed therapy, requiring either a switch to insulin, or addition of a second oral hypoglycemic agent.
The authors suggest that, since all three therapeutic arms were equally efficacious in maintaining hemoglobin A1C in this group of patients who had failed diet therapy, it is equally advantageous to use oral hypoglycemic agents as insulin therapy.
United Kingdom Prospective Diabetes Study Group. Ann Intern Med 1998; 128:165-175.
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