Morning or Bedtime NPH Insulin Combined With Sulfonylurea in Treatment of NIDDM

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Abstract
Objective To compare the effect of morning and bedtime NPH insulin combined with daytime sulfonylurea on glycemic control in non-insulin-dependent diabetes mellitus (NIDDM) patients no longer responding to treatment with sulfonylureas alone. Research Design and Methods Twenty-four NIDDM patients who fulfilled these criteria were randomized to treatment with Protaphan human insulin in the morning or at bedtime (22 ± 1 IU) plus 3.5 mg glibenclamide twice a day. Results Morning and bedtime NPH insulin resulted in equal reduction of HbA1 (from 13.5 ± 0.3 to 9.4 ± 0.1 and 9.6 ± 0.2%, respectively) and mean self-monitored blood glucose (9.2 ± 0.5 vs. 10.1 ± 0.4 mM). Bedtime insulin resulted in lower morning blood glucose (7.8 ± 0.5 vs. 9.1 ± 0.4 mM; P < 0.01), whereas morning insulin resulted in lower evening blood glucose (10.1 ± 0.6 vs 12.1 ± 0.6 mM, P < 0.01). Conclusions Morning and bedtime NPH insulin combined with glibenclamide are equipotent in the treatment of NIDDM patients with secondary failure to sulfonylurea. However, this treatment regimen normalizes blood glucose only in a small group of patients. Therefore, more intensified insulin therapy seems to be required to achieve this goal.

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