Insulin therapy sulphonylureas combination

Insulin treatment in Type 2 diabetes. When oral therapy fails, insulin treatment should be used alone or in combination with metformin. There is little advantage from adding insulin to a sulphonylurea. The advent of thiazolidinediones offers an alternative to combining metformin with insulin, but more experience of these drugs is required before their combination with metformin can be routinely recommended. It is important to stop the thiazo-lidinedione, if not effective, before progressing to insulin. Definitive evidence that institution of insulin will reduce complications is lacking however, there is an improvement in quality of life, with few patients requesting to stop insulin once they have... 

Combined insulin-sulphonylurea therapy appears to be an interesting alternative for treating diabetic patients with secondary failure to sulphonylureas (Berger, 1971 Mezitis etal., 1992). In addition to better glucose profiles and/or decreased insulin needs, which have been shown to persist after 1 year or more, the risk of hypoglycaemic episodes is rather small when insulin doses are adapted at the beginning of the combined therapy (Berger, 1971). 

According to modern pathophysiological understanding of Type-II diabetes and the mechanism of sulphonylurea action, combined insulin-sulphonylurea therapy appears to be an interesting alternative for treating NIDDM patients with secondary failure to sulphonylureas. Several recent clinical trials confirmed favourable results (Stenman et al., 1988). Holman et al. (1987) studied the metabolic profiles of 24 Type-II diabetics who were treated... 

Harashima SI, Ogura M, Tanaka D, Fukushima T, Wang Y, Koizumi T, et al. Sitagliptin add-on to low dosage sulphonylureas efficacy and safety of combination therapy on gjycaemic control and insulin secretion capacity in type 2 diabetes. Int J Clin Pract 2012 66(5) 465-76. 

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