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

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The Review of Diabetic Studies,2010,7,3,225-232.
Published:November 2010
Type:Original Article
Author(s) affiliations:

Michael Alvarsson1, Kerstin Berntorp2, Eva Fernqvist-Forbes3, Ibe Lager4, Lars Steen5, Thomas Örn6, and Valdemar Grill1,7

1Department of Endocrinology and Diabetology, Karolinska University Hospital, Stockholm, Sweden.

2Department of Endocrinology, Malmö University Hospital, Malmö, Sweden.

3Department of Medicine, Visby Hospital, Visby, Sweden.

4Department of Medicine, Kristianstad Hospital, Kristianstad, Sweden.

5Department of Medicine, Mälarsjukhuset, Eskilstuna, Sweden.

6Department of Medicine, Blekingesjukhuset, Karlskrona, Sweden.

7Department of Internal Medicine, St. Olav University Hospital, Trondheim, Norway.



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). Conclusion: Early insulin treatment preserves beta-cell secretory function better than glibenclamide even in a 6-year perspective.