Titre du document / Document title

Sulfonylurea inadequacy: Efficacy of addition of insulin over 6 years in patients with type 2 diabetes in the U.K. Prospective Diabetes Study (UKPDS 57)

Auteur(s) / Author(s)

U.K. Prospective Diabetes Study Group, ROYAUME-UNI
WRIGHT Alex ⁽¹⁾ ; BURDEN A. C. ⁽²⁾ ; PAISEY Richard B. ⁽³⁾ ; CULI Carole A. ⁽⁴⁾ ; HOLMAN Rury R. ⁽⁴⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ University Hospital, Birmingham, ROYAUME-UNI
⁽²⁾ University Hospitals of Leicester, Leicester, ROYAUME-UNI
⁽³⁾ Forbay Hospital, Torquay, Devon, ROYAUME-UNI
⁽⁴⁾ Diabetes Trials Unit, OCDEM, University of Oxford, Oxford, ROYAUME-UNI

Résumé / Abstract

OBJECTIVE - To evaluate the efficacy of the addition of insulin when maximal sulfonylurea therapy is inadequate in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS - Glycemic control, hypoglycemia, and body weight were monitored over 6 years in 826 patients with newly diagnosed type 2 diabetes in 8 of 23 U.K. Prospective Diabetes Study (UKPDS) centers that used a modified protocol. Patients were randomly allocated to a conventional glucose control policy, primarily with diet (n = 242) or an intensive policy with insulin alone (n = 245), as in the main study. However, for patients randomized to an intensive policy with sulfonylurea (n = 339), insulin was added automatically if the fasting plasma glucose remained >108 mg/dl (6.0 mmol/l) despite maximal sulfonylurea doses. RESULTS - Over 6 years, ∼53% of patients allocated to treatment with sulfonylurea required additional insulin therapy. Median HbA_1c in the sulfonylurea ± insulin group was significantly lower (6.6%, interquartile range [IQR] 6.0-7.6) than in the group taking it sulin alone (7.1%, IQR 6.2-8.0; P = 0.0066), and significantly more patients in the sulfonylurea ± insulin group had an HbA_1c <7% (47 vs. 35%, respectively; P = 0.011). Weight gain was similar in the intensive therapy groups, hut major hypoglycemia occurred less frequently over all n the sulfonylurea (± insulin) group compared with the insulin alone group (1.6 vs. 3.2% per arnum, respectively; P = 0.017) CONCLUSIONS - Early addition of insulin when maximal sulfonylurea therapy is inadequate can significantly improve glycemic control without promoting increased hypoglycemia or weight gain.

Revue / Journal Title

Diabetes care   ISSN 0149-5992   CODEN DICAD2 

Source / Source

2002, vol. 25, n^o2, pp. 330-336 (14 ref.)

Langue / Language

Anglais

Editeur / Publisher

American Diabetes Association, Alexandria, VA, ETATS-UNIS  (1978) (Revue)

Mots-clés anglais / English Keywords

Endocrinopathy ; Policy ; Glucose ; Diagnosis ; Body weight ; Control method ; Human ; Insulin ; Sulfonylureas ; Fasting ; Randomization ; Diet ; Treatment ; Hypoglycemia ; Non insulin dependent diabetes ;

Mots-clés français / French Keywords

Endocrinopathie ; Politique ; Glucose ; Diagnostic ; Poids corporel ; Méthode contrôle ; Homme ; Insuline ; Sulfonylurées ; Jeûne alimentaire ; Randomisation ; Régime alimentaire ; Traitement ; Hypoglycémie ; Diabète non insulinodépendant ;

Mots-clés espagnols / Spanish Keywords

Endocrinopatía ; Política ; Glucosa ; Diagnóstico ; Peso corporal ; Método control ; Hombre ; Insulina ; Sulfonilureas ; Ayuno alimenticio ; Aleatorización ; Régimen alimentario ; Tratamiento ; Hipoglicemia ; Diabetes no insulinodependiente ;

Localisation / Location

INIST-CNRS, Cote INIST : 18054, 35400010274281.0130