Beneficial Effects of Insulin Versus Sulphonylurea on Insulin Secretion and Metabolic Control in Recently Diagnosed Type 2 Diabetic Patients

Beneficial Effects of Insulin Versus Sulphonylurea on Insulin Secretion and Metabolic Control in Recently Diagnosed Type 2 Diabetic Patients Michael Alvarsson , MD, PHD 1 , Göran Sundkvist , MD, PHD 2 , Ibe Lager , MD, PHD 3 , Marianne Henricsson , MD, PHD 4 , Kerstin Berntorp , MD, PHD 2 , Eva Fernqvist-Forbes , MD, PHD 5 , Lars Steen , MD 6 , Gunilla Westermark , MD, PHD 7 , Per Westermark , MD, PHD 7 , Thomas Örn , MD 8 and Valdemar Grill , MD, PHD 1 1 Department of Endocrinology and Diabetology, Karolinska Hospital, Stockholm, Sweden 2 Department of Endocrinology, Malmö University Hospital, Malmö, Sweden 3 Department of Medicine, Kristianstad Hospital, Kristianstad, Sweden 4 Department of Ophthalmology, Helsingborg Hospital, Helsingborg, Sweden 5 Department of Medicine, Visby Hospital, Visby, Sweden 5 Department of Medicine, Mälarsjukhuset, Eskilstuna, Sweden 6 Division of Cell Biology, Faculty of Health Sciences, Linköping, Sweden 7 Department of Medicine, Blekingesjukhuset, Karlskrona, Sweden Address correspondence and reprint requests to Michael Alvarsson, Department of Endocrinology and Diabetology, Karolinska Hospital, SE-171 76 Stockholm, Sweden. E-mail: michael.alvarsson{at}ks.se Abstract OBJECTIVE —To evaluate whether treatment with insulin in recently diagnosed type 2 diabetes is advantageous compared with glibenclamide treatment. RESEARCH DESIGN AND METHODS —β-Cell function, glycemic control, and quality of life were monitored over 2 years in 39 patients with islet cell antibody-negative type 2 diabetes diagnosed 0–2 years before inclusion in a Swedish multicenter randomized clinical trial. Patients were randomized to either two daily injections of premixed 30% soluble and 70% NPH insulin or glibenclamide (3.5–10.5 mg daily). C-peptide-glucagon tests were performed yearly in duplicate after 2–3 days of temporary withdrawal of treatment. RESULTS —After 1 year the glucagon-stimulated C-peptide response was increased in the insulin-treated group by 0.14 ± 0.08 nmol/l, whereas it was decreased by 0.12 ± 0.08 nmol/l in the glibenclamide group, P < 0.02 for difference between groups. After 2 years, fasting insulin levels were higher after treatment withdrawal in the insulin-treated versus the glibenclamide-treated group ( P = 0.02). HbA 1c levels decreased significantly during the first year in both groups; however, at the end of the second year, HbA 1c had deteriorated in the glibenclamide group ( P < 0.01), but not in the insulin-treated group. T