engleski

INSULIN THERAPY OF NIDDM WITH BASAL INSULIN ONLY: REDISCOVERING THE MISSED PHYSIOLOGY

Appropriate diet and physical exercise followed by selfmonitoring and selfmanagement remain the main forms of therapy in NIDDM patients, but about 20% of patients need insulin to achieve acceptable glycemic control. This study was aimed to show whether basal insulin alone could ensure satisfactory control of blood glucose levels in NIDDM. We selected a group of twelve patients with type II diabetes in whom the treatment with oral hypoglycemic agents failed. The treatment with glibenclamide was discontinued, and one evening dose of long-acting insulin was introduced. Mean fasting glucose declined significantly six months after insulin introduction (from 13.08± 1.85 to 7.31± 2.95 mM/L ; p=0.00002), and so did HbA1c (from 10.61± 2.34% to 7.38± 1.37% ; p=0.0005). A slight, nonsignificant rise in body weight was observed (from 83.25± 13.76 to 83.33± 13.28 kg ; p=0.47). Only three mild hypoglycemic episodes were reported. We conclude that imitating basal insulin secretion in NIDDM patients who require insulin enables nearly as smooth a glycemic control as in healthy persons, without any major risk of hypoglycemia or weight gain.

NIDDM; insulin secretion; insulin therapy

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