Abstract
Whether a sulfonylurea may be used together with insulin for treating NIDDM has been
controversial. One view, based on older studies, has been that the additional benefit
is too small or the level of glucose control achieved usually too poor to recommend
this method. More recent studies of a more specific way of combining a sulfonylurea
with insulin are more supportive. When a single injection of insulin taken in the
evening is added to a sulfonylurea at the time of secondary failure of the sulfonylurea
alone, glycemic control is quite simply and consistently restored to acceptable levels.
At this time in the natural history of NIDDM, evening insulin combined therapy is
more effective than a single injection of insulin alone, and just as effective as
a more complex multiple-injection regimen without an oral agent. A recent multicenter
trial of a new sulfonylurea, glimepiride, in combination with a single injection of
70/30 insulin before dinner has confirmed that this approach is safe and more consistently
effective than insulin alone for obese patients beginning insulin in a setting resembling
clinical practice. The available evidence suggests this form of combined therapy is
suitable for routine use.
Key words
Sulfonylurea - Glimepiride - Insulin - Combined Therapy
