Comparison of bedtime NPH insulin or metformin combined with glibenclamide in secondary sulphonylurea failure in obese type II (NIDDM) patients.

OBJECTIVE To compare the effects of bedtime NPH Insulin vs Metformin combined with Glibenclamide in patients who are obese and had secondary failure to sulphonylurea treatment. DESIGN AND METHODS Prospective, randomized, comparative study of patients having type-II diabetes, without complications with associated obesity and secondary failure to sulphonylureas. Thirty-six obese patients who continued to have blood glucose values of fasting > 150 mg/dl and/or random > 220 mg/dl, after 8 weeks of intensive dietary and drug therapy. INTERVENTIONS For the 20 weeks of study, the patients were randomised in two equal groups, one receiving 20 to 40 units of NPH Insulin at bed time and the second group, Metformin upto a maximum dose of 3 grams, along with Sulphonylureas. RESULTS Both the groups showed, a significant reduction in the blood glucose values, with an average decrease of 50 mg/dl. The other monitored parameters, such as, serum cholesterol, triglycerides and blood pressure values, also demonstrated a similar downwards trend. However, the drop out rate was high in the Insulin treated group and the remainder group did show slight increase in weight and BMI, while the reverse, stood true, for the metformin group, with 100% compliance rate. CONCLUSION Metformin, in obese, type II diabetics, with secondary failure to Sulphonylureas, is an effective, safe and well tolerated treatment, which not only improves the metabolic control but also favourably modifies other parameters such as weight, total cholesterol and triglyceride values.