Efficacy of combined treatments in NIDDM patients with secondary failure to sulphonylureas. Is it predictable?

V. Trischitta, S. Italia, M. Raimondo, V. Guardabasso, C. Licciardello, F. Runello, S. Mazzarino, L. Sangiorgi, M. Anello, R. Vigneri

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

The treatment of NIDDM patients with secondary failure to sulphonylurea is a common problem. We performed a crossover study in 50 NIDDM patients with secondary failure to glibenclamide by comparing the addition to sulphonylurea of either a low-dose bedtime NPH insulin or a t.i.d. oral metformin and by analyzing treatment efficacy in relation to patient and disease characteristics. Both combined therapies clearly improved glycaemic control. HbA1c were similarly reduced by the addition of either bedtime NPH insulin (7.6 ± 0.34 vs 8.7 ± 0.35, p <0.01) or metformin (7.6 ± 0.22 vs 8.6 ± 0.31, p <0.01). Also fasting plasma glucose (FPG) and post-prandial plasma glucose (PPPG) significantly decreased (p <0.01) with both treatments. Bedtime NPH insulin was more effective on FPG reduction than metformin (-36 ± 2% vs -25 ± 2%, p <0.01); in contrast, metformin addition was more effective on PPPG reduction than bedtime NPH insulin addition (-30 ± 2% vs 20 ± 3%, p <0.01). Serum cholesterol was marginally but significantly decreased after metformin (5.49 ± 0.19 vs 5.91 ± 0.18 mM, p <0.05) but not after NPH insulin. Body weight increase was significantly greater after insulin addition than after metformin (1.47 ± 0.25 Kg vs 0.64 ± 0.17 p = 0.02). All patients preferred the addition of metformin rather than NPH insulin. None of the measured clinical and metabolic variables (before treatment FPG and PPPG, HbA1c, post-glucagon C-peptide levels, insulin sensitivity, patient age, BMI and diabetes duration) significantly correlated to the efficacy of the two combined treatments studied. In conclusion, in NIDDM patients with secondary failure to sulphonylureas the addition of either low-dose bedtime NPH insulin or t.i.d. metformin is similarly effective in improving glycaemic control. Metformin is better accepted by patients and provides a modest advantage in terms of body weight and cholesterol levels. The most common clinical and metabolic variables are not useful for predicting the efficacy of these two combined treatments.

Original languageEnglish
Pages (from-to)744-747
Number of pages4
JournalJournal of Endocrinological Investigation
Volume21
Issue number11
Publication statusPublished - 1998

Fingerprint

Metformin
Isophane Insulin
Type 2 Diabetes Mellitus
Glucose
Meals
Fasting
Therapeutics
Cholesterol
Body Weight
Glyburide
C-Peptide
Glucagon
Cross-Over Studies
Insulin Resistance
Insulin

Keywords

  • Combined treatments
  • Prediction of efficacy
  • Secondary failure to sulphonylurea

ASJC Scopus subject areas

  • Endocrinology

Cite this

Trischitta, V., Italia, S., Raimondo, M., Guardabasso, V., Licciardello, C., Runello, F., ... Vigneri, R. (1998). Efficacy of combined treatments in NIDDM patients with secondary failure to sulphonylureas. Is it predictable? Journal of Endocrinological Investigation, 21(11), 744-747.

Efficacy of combined treatments in NIDDM patients with secondary failure to sulphonylureas. Is it predictable? / Trischitta, V.; Italia, S.; Raimondo, M.; Guardabasso, V.; Licciardello, C.; Runello, F.; Mazzarino, S.; Sangiorgi, L.; Anello, M.; Vigneri, R.

In: Journal of Endocrinological Investigation, Vol. 21, No. 11, 1998, p. 744-747.

Research output: Contribution to journalArticle

Trischitta, V, Italia, S, Raimondo, M, Guardabasso, V, Licciardello, C, Runello, F, Mazzarino, S, Sangiorgi, L, Anello, M & Vigneri, R 1998, 'Efficacy of combined treatments in NIDDM patients with secondary failure to sulphonylureas. Is it predictable?', Journal of Endocrinological Investigation, vol. 21, no. 11, pp. 744-747.
Trischitta, V. ; Italia, S. ; Raimondo, M. ; Guardabasso, V. ; Licciardello, C. ; Runello, F. ; Mazzarino, S. ; Sangiorgi, L. ; Anello, M. ; Vigneri, R. / Efficacy of combined treatments in NIDDM patients with secondary failure to sulphonylureas. Is it predictable?. In: Journal of Endocrinological Investigation. 1998 ; Vol. 21, No. 11. pp. 744-747.
@article{a33054e49c27497786c51da03b767495,
title = "Efficacy of combined treatments in NIDDM patients with secondary failure to sulphonylureas. Is it predictable?",
abstract = "The treatment of NIDDM patients with secondary failure to sulphonylurea is a common problem. We performed a crossover study in 50 NIDDM patients with secondary failure to glibenclamide by comparing the addition to sulphonylurea of either a low-dose bedtime NPH insulin or a t.i.d. oral metformin and by analyzing treatment efficacy in relation to patient and disease characteristics. Both combined therapies clearly improved glycaemic control. HbA1c were similarly reduced by the addition of either bedtime NPH insulin (7.6 ± 0.34 vs 8.7 ± 0.35, p <0.01) or metformin (7.6 ± 0.22 vs 8.6 ± 0.31, p <0.01). Also fasting plasma glucose (FPG) and post-prandial plasma glucose (PPPG) significantly decreased (p <0.01) with both treatments. Bedtime NPH insulin was more effective on FPG reduction than metformin (-36 ± 2{\%} vs -25 ± 2{\%}, p <0.01); in contrast, metformin addition was more effective on PPPG reduction than bedtime NPH insulin addition (-30 ± 2{\%} vs 20 ± 3{\%}, p <0.01). Serum cholesterol was marginally but significantly decreased after metformin (5.49 ± 0.19 vs 5.91 ± 0.18 mM, p <0.05) but not after NPH insulin. Body weight increase was significantly greater after insulin addition than after metformin (1.47 ± 0.25 Kg vs 0.64 ± 0.17 p = 0.02). All patients preferred the addition of metformin rather than NPH insulin. None of the measured clinical and metabolic variables (before treatment FPG and PPPG, HbA1c, post-glucagon C-peptide levels, insulin sensitivity, patient age, BMI and diabetes duration) significantly correlated to the efficacy of the two combined treatments studied. In conclusion, in NIDDM patients with secondary failure to sulphonylureas the addition of either low-dose bedtime NPH insulin or t.i.d. metformin is similarly effective in improving glycaemic control. Metformin is better accepted by patients and provides a modest advantage in terms of body weight and cholesterol levels. The most common clinical and metabolic variables are not useful for predicting the efficacy of these two combined treatments.",
keywords = "Combined treatments, Prediction of efficacy, Secondary failure to sulphonylurea",
author = "V. Trischitta and S. Italia and M. Raimondo and V. Guardabasso and C. Licciardello and F. Runello and S. Mazzarino and L. Sangiorgi and M. Anello and R. Vigneri",
year = "1998",
language = "English",
volume = "21",
pages = "744--747",
journal = "Journal of Endocrinological Investigation",
issn = "0391-4097",
publisher = "Springer International Publishing",
number = "11",

}

TY - JOUR

T1 - Efficacy of combined treatments in NIDDM patients with secondary failure to sulphonylureas. Is it predictable?

AU - Trischitta, V.

AU - Italia, S.

AU - Raimondo, M.

AU - Guardabasso, V.

AU - Licciardello, C.

AU - Runello, F.

AU - Mazzarino, S.

AU - Sangiorgi, L.

AU - Anello, M.

AU - Vigneri, R.

PY - 1998

Y1 - 1998

N2 - The treatment of NIDDM patients with secondary failure to sulphonylurea is a common problem. We performed a crossover study in 50 NIDDM patients with secondary failure to glibenclamide by comparing the addition to sulphonylurea of either a low-dose bedtime NPH insulin or a t.i.d. oral metformin and by analyzing treatment efficacy in relation to patient and disease characteristics. Both combined therapies clearly improved glycaemic control. HbA1c were similarly reduced by the addition of either bedtime NPH insulin (7.6 ± 0.34 vs 8.7 ± 0.35, p <0.01) or metformin (7.6 ± 0.22 vs 8.6 ± 0.31, p <0.01). Also fasting plasma glucose (FPG) and post-prandial plasma glucose (PPPG) significantly decreased (p <0.01) with both treatments. Bedtime NPH insulin was more effective on FPG reduction than metformin (-36 ± 2% vs -25 ± 2%, p <0.01); in contrast, metformin addition was more effective on PPPG reduction than bedtime NPH insulin addition (-30 ± 2% vs 20 ± 3%, p <0.01). Serum cholesterol was marginally but significantly decreased after metformin (5.49 ± 0.19 vs 5.91 ± 0.18 mM, p <0.05) but not after NPH insulin. Body weight increase was significantly greater after insulin addition than after metformin (1.47 ± 0.25 Kg vs 0.64 ± 0.17 p = 0.02). All patients preferred the addition of metformin rather than NPH insulin. None of the measured clinical and metabolic variables (before treatment FPG and PPPG, HbA1c, post-glucagon C-peptide levels, insulin sensitivity, patient age, BMI and diabetes duration) significantly correlated to the efficacy of the two combined treatments studied. In conclusion, in NIDDM patients with secondary failure to sulphonylureas the addition of either low-dose bedtime NPH insulin or t.i.d. metformin is similarly effective in improving glycaemic control. Metformin is better accepted by patients and provides a modest advantage in terms of body weight and cholesterol levels. The most common clinical and metabolic variables are not useful for predicting the efficacy of these two combined treatments.

AB - The treatment of NIDDM patients with secondary failure to sulphonylurea is a common problem. We performed a crossover study in 50 NIDDM patients with secondary failure to glibenclamide by comparing the addition to sulphonylurea of either a low-dose bedtime NPH insulin or a t.i.d. oral metformin and by analyzing treatment efficacy in relation to patient and disease characteristics. Both combined therapies clearly improved glycaemic control. HbA1c were similarly reduced by the addition of either bedtime NPH insulin (7.6 ± 0.34 vs 8.7 ± 0.35, p <0.01) or metformin (7.6 ± 0.22 vs 8.6 ± 0.31, p <0.01). Also fasting plasma glucose (FPG) and post-prandial plasma glucose (PPPG) significantly decreased (p <0.01) with both treatments. Bedtime NPH insulin was more effective on FPG reduction than metformin (-36 ± 2% vs -25 ± 2%, p <0.01); in contrast, metformin addition was more effective on PPPG reduction than bedtime NPH insulin addition (-30 ± 2% vs 20 ± 3%, p <0.01). Serum cholesterol was marginally but significantly decreased after metformin (5.49 ± 0.19 vs 5.91 ± 0.18 mM, p <0.05) but not after NPH insulin. Body weight increase was significantly greater after insulin addition than after metformin (1.47 ± 0.25 Kg vs 0.64 ± 0.17 p = 0.02). All patients preferred the addition of metformin rather than NPH insulin. None of the measured clinical and metabolic variables (before treatment FPG and PPPG, HbA1c, post-glucagon C-peptide levels, insulin sensitivity, patient age, BMI and diabetes duration) significantly correlated to the efficacy of the two combined treatments studied. In conclusion, in NIDDM patients with secondary failure to sulphonylureas the addition of either low-dose bedtime NPH insulin or t.i.d. metformin is similarly effective in improving glycaemic control. Metformin is better accepted by patients and provides a modest advantage in terms of body weight and cholesterol levels. The most common clinical and metabolic variables are not useful for predicting the efficacy of these two combined treatments.

KW - Combined treatments

KW - Prediction of efficacy

KW - Secondary failure to sulphonylurea

UR - http://www.scopus.com/inward/record.url?scp=0032434317&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032434317&partnerID=8YFLogxK

M3 - Article

VL - 21

SP - 744

EP - 747

JO - Journal of Endocrinological Investigation

JF - Journal of Endocrinological Investigation

SN - 0391-4097

IS - 11

ER -