Skip to main content
PMC home page
British Medical Journal (Clinical Research Ed.) logoLink to British Medical Journal (Clinical Research Ed.)
. 1984 Jun 30;288(6435):1956–1959. doi: 10.1136/bmj.288.6435.1956

The difficult choice of treatment for poorly controlled maturity onset diabetes: tablets or insulin?

I Peacock, R B Tattersall
PMCID: PMC1442249  PMID: 6428619

Abstract

Patients with maturity onset diabetes that is poorly controlled on maximal doses of oral hypoglycaemic agents are difficult to treat. A prospective randomised crossover study was performed in 58 predominantly non-obese patients on maximal doses of glibenclamide or metformin, or both, to find out if insulin would improve control or well being. The patients were given daily injections of up to 48 units of highly purified porcine lente insulin. Glycaemic control was improved by 15% or more in only 18 patients; 14 others felt better but their diabetes was no better controlled. Those whose control was improved by insulin could not be distinguished by age, duration of diabetes, body mass index, or their own treatment preference. C peptide concentrations, however, did help predict the response to insulin, the fasting C peptide to glucose ratio being considerably lower in those patients whose control was better on insulin. These findings suggest that a simple insulin regimen does not necessarily lead to better glycaemic control in maturity onset diabetes. Nevertheless, a trial of insulin is often justified since it poses few practical difficulties and makes some patients feel better even if their control is not improved. A more complex regimen might improve control in more cases, but it might also be less acceptable to older patients.

Full text

PDF
1957

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beischer W., Kerner W., Raptis S., Keller L., Beischer B., Pfeiffer E. F. Insulin therapy in relation to circulating C-peptide levels. Diabetes. 1978;27 (Suppl 1):235–240. doi: 10.2337/diab.27.1.s235. [DOI] [PubMed] [Google Scholar]
  2. COLWELL A. R. Treatment of diabetes selection of technic according to severity. Diabetes. 1953 Jul-Aug;2(4):262–267. doi: 10.2337/diab.2.4.262. [DOI] [PubMed] [Google Scholar]
  3. DeFronzo R. A., Ferrannini E. The pathogenesis of non-insulin-dependent diabetes: an update. Medicine (Baltimore) 1982 May;61(3):125–140. doi: 10.1097/00005792-198205000-00001. [DOI] [PubMed] [Google Scholar]
  4. Eaton R. P., Galagan R., Kaufman E., Allen R. C., Russell L., Miller F. Receptor depletion in diabetes mellitus: correction with therapy. Diabetes Care. 1981 Mar-Apr;4(2):299–304. doi: 10.2337/diacare.4.2.299. [DOI] [PubMed] [Google Scholar]
  5. Feinglos M. N., Lebovitz H. E. Sulfonylurea treatment of insulin-independent diabetes mellitus. Metabolism. 1980 May;29(5):488–494. doi: 10.1016/0026-0495(80)90175-4. [DOI] [PubMed] [Google Scholar]
  6. Ginsberg H., Rayfield E. J. Effect of insulin therapy on insulin resistance in type II diabetic subjects. Evidence for heterogeneity. Diabetes. 1981 Sep;30(9):739–745. doi: 10.2337/diab.30.9.739. [DOI] [PubMed] [Google Scholar]
  7. Heding L. G. Radioimmunological determination of human C-peptide in serum. Diabetologia. 1975 Dec;11(6):541–548. doi: 10.1007/BF01222104. [DOI] [PubMed] [Google Scholar]
  8. Hoekstra J. B., Van Rijn H. J., Thijssen J. H., Erkelens D. W. C-peptide reactivity as a measure of insulin dependency in obese diabetic patients treated with insulin. Diabetes Care. 1982 Nov-Dec;5(6):585–591. doi: 10.2337/diacare.5.6.585. [DOI] [PubMed] [Google Scholar]
  9. Holman R. R., Turner R. C. Diabetes: The quest for basal normoglycaemia. Lancet. 1977 Feb 26;1(8009):469–474. doi: 10.1016/s0140-6736(77)91954-7. [DOI] [PubMed] [Google Scholar]
  10. Holman R. R., Turner R. C. The basal plasma glucose: a simple relevant index of maturity-onset diabetes. Clin Endocrinol (Oxf) 1981 Mar;14(3):279–286. doi: 10.1111/j.1365-2265.1981.tb00196.x. [DOI] [PubMed] [Google Scholar]
  11. Howe-Davies S., Holman R. R., Phillips M., Turner R. C. Home blood sampling for plasma glucose assay in control of diabetes. Br Med J. 1978 Aug 26;2(6137):596–598. doi: 10.1136/bmj.2.6137.596. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kolterman O. G., Prince M. J., Olefsky J. M. Insulin resistance in noninsulin-dependent diabetes mellitus: impact of sulfonylurea agents in vivo and in vitro. Am J Med. 1983 Jan 17;74(1A):82–101. doi: 10.1016/0002-9343(83)90655-1. [DOI] [PubMed] [Google Scholar]
  13. Kromann H., Borch E., Gale E. A. Unnecessary insulin treatment for diabetes. Br Med J (Clin Res Ed) 1981 Nov 21;283(6303):1386–1388. doi: 10.1136/bmj.283.6303.1386. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Madsbad S., Krarup T., McNair P., Christiansen C., Faber O. K., Transbøl I., Binder C. Practical clinical value of the C-peptide response to glucagon stimulation in the choice of treatment in diabetes mellitus. Acta Med Scand. 1981;210(3):153–156. doi: 10.1111/j.0954-6820.1981.tb09793.x. [DOI] [PubMed] [Google Scholar]
  15. Reaven G. M., Bernstein R., Davis B., Olefsky J. M. Nonketotic diabetes mellitus: insulin deficiency or insulin resistance? Am J Med. 1976 Jan;60(1):80–88. doi: 10.1016/0002-9343(76)90536-2. [DOI] [PubMed] [Google Scholar]
  16. Rendell M., Slevin D., Meltz G., Simpson J., Barquet A. A case of maturity-onset diabetes mellitus resistant to insulin but responsive to tolbutamide. Ann Intern Med. 1979 Feb;90(2):195–197. doi: 10.7326/0003-4819-90-2-195. [DOI] [PubMed] [Google Scholar]
  17. SEGRE E. J. Diabetes mellitus with insulin resistance: report of a case successfully treated with tolbutamide. Metabolism. 1962 Jun;11:562–565. [PubMed] [Google Scholar]
  18. SINGER D. L., STEWART R. C., HURWITZ D. Chlorpropamide in patients on high insulin dosage. N Engl J Med. 1961 Oct 26;265:823–826. doi: 10.1056/NEJM196110262651702. [DOI] [PubMed] [Google Scholar]
  19. Scarlett J. A., Gray R. S., Griffin J., Olefsky J. M., Kolterman O. G. Insulin treatment reverses the insulin resistance of type II diabetes mellitus. Diabetes Care. 1982 Jul-Aug;5(4):353–363. doi: 10.2337/diacare.5.4.353. [DOI] [PubMed] [Google Scholar]
  20. Turkington R. W., Estkowski A., Link M. Secretion of insulin or connecting peptide: a predictor of insulin dependence of obese "diabetics". Arch Intern Med. 1982 Jun;142(6):1102–1105. [PubMed] [Google Scholar]
  21. Turner R. C., Mathews D. R., Holman R. R., Peto J. Relative contributions of insulin deficiency and insulin resistance in maturity-onset diabetes. Lancet. 1982 Mar 13;1(8272):596–598. doi: 10.1016/s0140-6736(82)91753-6. [DOI] [PubMed] [Google Scholar]
  22. Webb P. G., Bonser A. M. Basal C-peptide in the discrimination of type I from type II diabetes. Diabetes Care. 1981 Nov-Dec;4(6):616–619. doi: 10.2337/diacare.4.6.616. [DOI] [PubMed] [Google Scholar]

Articles from British Medical Journal (Clinical research ed.) are provided here courtesy of BMJ Publishing Group

RESOURCES