Combination sulfonylurea and insulin therapy in non-insulin-dependent diabetes mellitus

Clinicians are frequently faced with treating non-insulin-dependent diabetics (NIDDM) who do not exhibit optimal glycemic control on maximal dosages of oral sulfonylurea agents or large dosages of insulin. Sustained hyperglycemia is implicated in the onset and progression of retinopathy, nephropathy, and neuropathy. Recent studies also suggest that hyperinsulinemia contributes to hypertension and altered lipid levels. Hence, the maintenance of euglycemia with minimal circulating insulin concentrations is the prime goal of therapy. Most studies document that the efficacy of combination therapy requires smaller insulin doses, enhances glycemic control without adverse effects on body weight or lipids, and decreases hypoglycemic episodes compared with insulin monotherapy. Therefore, combination therapy may be the optimal therapeutic option in NIDDM clients manifesting secondary failure to oral agents or insulin resistance.