The Review of Diabetic Studies

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

Michael Alvarsson, Valdemar Grill
Department of Endocrinology and Diabetology, Karolinska University Hospital, Stockholm, Sweden
Kerstin Berntorp
Department of Endocrinology, Malmö University Hospital, Malmö, Sweden.
Eva Fernqvist-Forbes
Department of Medicine, Visby Hospital, Visby, Sweden
Ibe Lager
Department of Medicine, Kristianstad Hospital, Kristianstad, Sweden
Lars Steen
Department of Medicine, Mälarsjukhuset, Eskilstuna, Sweden
Thomas Örn
Department of Medicine, Blekingesjukhuset, Karlskrona, Sweden


BACKGROUND: Early insulin treatment is considered more beneficial than anti-diabetic medication with sulphonylureas, because the latter may exert negative effects on betacell 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.

type 2 diabetes · beta-cell function · insulin secretion · sulphonylurea · islet amyloid polypeptide,.



Demosthenes Panagiotakos

Abbreviation Title

Rev Diabet Stud