[Combination therapy with insulin and sulfonylurea in secondary failure of sulfonylurea therapy]

Among 16 type II diabetics who were secondary failures on sulphonylurea treatment alone, eight (group A) were changed to a combined regimen of insulin and sulphonylurea (glibenclamide), the other eight (group B) received insulin alone. Patients in group A were on the combined schedule for ten days, followed by ten days of insulin alone, followed by six months of combined treatment. In the first ten days those on combined treatment in group A required on average 30% less insulin that those of group B, with a comparable metabolic state, while insulin requirements significantly rose after ten days on insulin alone. After renewed combined treatment the insulin dose could once again be reduced, but after eight weeks there was a rise in the insulin requirement, as for group B patients. During the further observation period of three months there were no significant differences in the insulin requirement between the two groups. Combination treatment with sulphonylurea and insulin in secondary failures thus, in the short term, reduces insulin requirement; but in the long term it is not significantly different from insulin treatment alone.