Volume 53, Issue 3 p. 380-384
Clinical Trials and Therapeutics

Bedtime insulin added to daytime sulfonylureas improves glycemic control in uncontrolled type II diabetes

Jeffrey L Miller MD

Corresponding Author

Jeffrey L Miller MD

Department of Medicine, Division of Endocrinology and Metabolism, Hahnemann University School of Medicine

Jeffrey L Miller, MD Hahnemann University Hospital, Division of Endocrinology and Metabolism, 230 North Broad St., MS No. 426, Philadelphia, PA 19102.Search for more papers by this author
Karl Salman MD

Karl Salman MD

Department of Medicine, Division of Endocrinology and Metabolism, Hahnemann University School of Medicine

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Leon H Shulman MD

Leon H Shulman MD

Department of Medicine, Division of Endocrinology and Metabolism, Hahnemann University School of Medicine

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Leslie I Rose MD

Leslie I Rose MD

Department of Medicine, Division of Endocrinology and Metabolism, Hahnemann University School of Medicine

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First published: March 1993

Abstract

Background: To evaluate the possible benefits of the addition of intermediate-acting insulin administered at bedtime to therapy with daytime sulfonylureas in patients with non-insulin-dependent diabetes mellitus for whom maximal doses of oral hypoglycemic agents have not been successful.

Methods: Study subjects were 16 consecutive obese patients aged from 44 to 78 years (mean age, 62 years) with histories of non-insulin-dependent diabetes mellitus for a mean of 9 years. None of the subjects had been able to control their diabetes with maximal doses of oral hypoglycemic agents. All patients received 20 mg glipizide or 10 mg glyburide twice a day, as well as education about the American Diabetes Association diet. Neutral protamine Hagedorn (NPH) insulin was empirically added in doses from 0.1 to 0.2 units/kg given at bedtime. The dose was adjusted on the basis of fasting blood glucose levels.

Results: Mean fasting blood glucose decreased from 13.7 ± 3.4 to 8.3 ± 2.7 mmol/L at 3 months and 7.3 + 2.0 mmol/L at 1 year. Glycosylated hemoglobin decreased from 9.0% ± 1.9% to 6.2% ± 1.16% at 3 months and 6.3% ± 1.22% at 1 year.

Conclusion: A late-night dose of NPH insulin was added to a regimen of daytime sulfonylureas in a group of obese patients with type II diabetes whose hyperglycemia was not controlled with maximal doses of oral hypoglycemic agents. This treatment proved to be beneficial and is a useful alternative to conventional insulin therapy in this group of patients.

Clinical Pharmacology and Therapeutics (1993) 53, 380–384; doi:10.1038/clpt.1993.36