The treatment of NIDDM in the decade of the 90s

On the occasion of the introduction of gliclazide (Diamicron) in Canada, it seems useful to assess the use of oral hypoglycemics in the treatment of NIDDM. Various types of diabetes occur when insufficient insulin is produced or when various factors reduce the receptor efficacy. Most of the factors involved are favorably affected by the action of sulfonylureas. Many NIDDM patients exhibit poor compliance with regard to exercise and diet, and require oral hypoglycemics. Combinations of oral hypoglycemics and insulin are very useful in patients responding poorly to either type of treatment since this gives effective insulin levels with improved receptor activity. Diamicron offers advantages since it reduces blood glucose effectively, has few side effects and no evidence of long-term problems or toxicity. Studies have shown that there is a significant antiplatelet aggregation effect and a beneficial effect on the fibrinolytic system with gliclazide (but not necessarily with other oral hypoglycemics), which may be useful in preventing or attenuating some long-term complications of diabetes, e.g. diabetic retinopathy. In a study at the Joslin Clinic, three groups of patients with NIDDM were examined: dietary failures, secondary failures with first generation oral hypoglycemics, and poorly regulated patients treated with insulin. After three months of treatment with Diamicron, all 10 dietary failure patients improved, as did three of the 10 secondary failure cases and five of the insulin-treated patients. Receptor studies indicated increased sensitivity in some cases, without a consistent change in numbers. Some patients with the poorest response to insulin alone had the best results with combined therapy, although it took almost eight weeks to achieve this.