Comparison of continual insulin or secretagogue treatment in type 2 diabetic patients with alternate insulin-secretagogue administration

Background: To compare the compliance and efficacy among three treatment modalities in patients of type 2 diabetes with fairly good islet function. Methods: This 38-month open, randomized, prospective study enrolled 536 subjects (HbA1c 9.4 +/- 0.8%). Patients were divided into three groups including continual insulin injection (I), continual secretagogue administration (S) and alternation of two-month insulin injection and four-month secretagogue treatment (A). At baseline and every three months, HbA1c was measured and a standard bread meal test (100 g) was performed. Results: HbA1c were better controlled in both groups I and A than in S (6.9 +/- 0.3%, 6.8 +/- 0.3% vs. 7.6 +/- 0.5%). Hypoglycemia incidence was much lower in group A than that in 1 (0.8 times/patient/month vs. 2.4 times/patient/month) also with less weight gain (1.6 kg vs. 2.8 kg/patient/year). From the standard bread meal test, patients in group A got the greatest increment of 2-h C-peptide. Inquiry from all subjects showed that alternate strategy was welcomed by most of them considering for convenience and efficacy. Conclusions: Alternate insulin-secretagogue treatment can effectively reduce HbA1c and help to improve islet function with reduced risk of hypoglycemia and weight gain under good compliance. (C) 2009 Elsevier Ireland Ltd. All rights reserved.