Combined Insulin-Glibenclamide Therapy of NIDDM Patients in Primary Health Care: A follow-up study of its compliance and efficacy and a review of the literature

Abstract

Twenty non-insulin-dependent diabetic (NIDDM) patients with secondary failure to sulphonylureas were given combined insulin-glibenclamide therapy. After discharge they were followed for the following 12 months at different primary care centres. In the 19 patients who completed the combined therapy, the mean glycosylated haemoglobin Ale (HbAlc) level decreased from 11.2 ± 0.5% to 9.1 ± 0.3% at 2 months (p < 0.001), and remained at 9.1 ± 0.4% at 12 months. The reduction of HbAlc was positively correlated with the HbAlc value and inversely with the initial body weight (both p < 0.05). There was a slight rise in the body mass index (BMI) from 26.9 ± 0.9 to 28.2 ± 0.7 at 12 months (p < 0.001), which was inversely correlated with the BMI value at 0 month (p < 0.05). The insulin doses were similar at 2 and 12 months. A review of the literature since 1985 identified ten double-blind, controlled studies on combined insulin-sulphonylurea therapy, comprising 156 NIDDM patients followed for 8–52 weeks. Improved glycaemic control and endogenous insulin secretion were documented in nine of these studies in parallel with a decrease of insulin requirement in six studies. We conclude from our own experience and the literature that combined insulin-glibenclamide therapy is an efficient and compliant therapeutic regimen.

Key Words:

• non-insulin-dependent diabetes mellitus
• insulin therapy
• glibenclamide
• sulpho-nylurea compounds