Motion Index: a new parameter to evaluate the diastole by M-Mode imaging.

AIM: Heart failure with normal left ventricle (LV) ejection fraction is commonly understood as diastolic heart failure because this expression implies the presence of LV diastolic dysfunction diagnosed by specific echocardiographic findings, such as slow LV relaxation and increased LV stiffness. In this work the authors propose a new parameter named Motion Index, which is measurable by M-Mode technique and it is likely linked to diastolic dysfunction. METHODS: A patient population composed by 134 subjects was enrolled. They all were in New York Heart Association (NYHA) functional class II. Echocardiogram carried out in all patients allowed the authors to distinguish 2 patient arms depending on the presence or absence of diastolic dysfunction, evaluated by flow Doppler and tissue Doppler. RESULTS: After carrying out every echocardiographic examination, the authors also measured the new parameter that called Motion Index, and found that it had an average value of 46 in patients with normal diastolic function and 33.5 in patients with diastolic dysfunction. This parameter did not depend on systolic dysfunction. CONCLUSIONS: Data obtained showed a statistically significant correlation between Motion Index and means of diastolic function assessed by both flow and tissue Doppler.

Impaired glucose metabolism in patients with acute stroke and no previous diagnosis of diabetes mellitus.

BACKGROUND: About a third of patients with acute stroke and no prior diagnosis of diabetes have hyperglycaemia during the acute phase of stroke. Whether this is an acute stress response or a reflection of underlying diabetes is controversial. AIM: To assess whether impaired glucose metabolism in patients with acute ischaemic stroke and no previous diagnosis of diabetes persists after 3 months, and whether such persistence can be predicted. DESIGN: Prospective observational study. METHODS: We enrolled 106 patients with acute ischaemic stroke and no history of diabetes. Fasting blood glucose, serum insulin and the insulin resistance index HOMA were recorded during hospital stay. A standard oral glucose tolerance test was performed at discharge and 3 months later. RESULTS: Ten patients did not complete the study. Eighty-one patients (84.4%) had abnormal glucose metabolism at discharge and 62 (64.6%) after 3 months. Thirty-seven (38.5%) had impaired glucose tolerance at discharge and 26 (27.1%) after 3 months. Forty-four (45.8%) had diabetes at discharge, and 36 (37.5%) at 3 months. Post-load hyperglycaemia at discharge was a predictor of diabetes after 3 months. A plasma glucose cut-off of 11.7 mmol/l (210 mg/dl) had a specificity of 90.0% and a positive predictive value of 81.3%. HOMA increased progressively from patients with normal glucose metabolism to those with newly diagnosed diabetes. DISCUSSION: Impaired glucose tolerance and previously unrecognized diabetes could be detected early in the stroke course, and persisted after 3 months in more than two-thirds of our patients. Post-load hyperglycaemia during the acute phase of stroke may be useful in identifying patients with abnormal glucose metabolism, which places them at risk for adverse outcomes, including cardiovascular disease.

Prevention of spontaneous autoimmune diabetes in diabetes-prone BB rats by prophylactic treatment with antirat interferon-gamma antibody.

The role of endogenous interferon-gamma (IFN gamma) in the development of insulin-dependent diabetes mellitus (IDDM) in diabetes-prone BB rats was evaluated. Several groups of these animals were treated under different, experimental conditions with a purified polyclonal antibody (Ab), antirat IFN gamma. The results show that when administered at doses of 100 or 200 micrograms/week from the 30/33th until the 105th day of age, the anti-IFN gamma Ab reversibly reduced the incidence of IDDM compared to that in control rats treated with either irrelevant rabbit IgG or PBS. Moreover, when given up to the 105th day of age, these doses of anti-IFN gamma Abs exerted comparable preventive effects regardless of whether application started as early as within 24 h after birth or at the end of the prediabetic period (e.g. 70/75 days). In contrast, under none of the above experimental conditions did larger doses of anti-IFN gamma Ab (500 micrograms or 1 mg/week) exert antidiabetogenic effects in the BB rats. Apparently, this was due to the exuberant production of neutralizing Abs elicited by the large amount of the xenogeneic Ab injected. At histoimmunological analyses, the BB rats treated with 200 micrograms/ week anti-IFN gamma Abs from 30-80 days of age exhibited a milder insulitic process along with diminished spleen frequency of activated lymphoid cells (MHC class II and interleukin-2 receptor positive). Taken together, these results provide further in vivo evidence for the central pathogenic role of IFN gamma in BB rat IDDM and anticipate the usefulness of specific IFN gamma inhibitors in the prevention of the disease in the clinical setting. Defining novel and less immunogenic forms of specific IFN gamma inhibitors than xenogeneic Abs is important for improving the efficiency of anti-IFN gamma-oriented approaches.

Enhanced percentage of CD5+ B lymphocytes in newly diagnosed IDDM patients.

The percentage of CD5+ B lymphocytes, the prevalence of islet cell antibodies (ICA) and of anti-insulin autoantibodies (IAA) and HLA-A-B-C and DR antigens were studied in 32 newly diagnosed insulin-dependent diabetes mellitus (IDDM) patients, in 12 non-insulin-dependent diabetes mellitus (NIDDM) patients and in 12 healthy subjects. The percentage of CD5+ B lymphocytes ranged from 18% to 51.2% (mean 40.3 +/- 11%) in IDDM patients, whereas in NIDDM patients and in controls it ranged from 20% to 25.2%, (mean 21.3 +/- 4.1%) and from 16% to 24%, (mean 19.3 +/- 1.9%), respectively (P less than 0.01 vs. NIDDM patients and vs. controls). There was no correlation between a higher percentage of CD5+ B lymphocytes and the presence of ICA and/or IAA, and their titres, and/or of any HLA-A-B-C and DR antigens. Thus, an enhanced percentage of CD5+ B lymphocytes may be present in newly diagnosed IDDM patients; the possible role of this cell type in the pathogenesis of IDDM needs further investigation.

Enhanced percentage of Leu M3+DR+ and Leu M3+CD25+ cells in newly diagnosed IDDM patients.

The percentage of Leu M3+DR+ and of Leu M3+CD25+ cells was determined by means of immunofluorescence analysis in a group of patients with insulin dependent diabetes mellitus (IDDM). Our results show that an increased percentage of these cells may occur in the early stage of the disease. These data provide evidence for a "phenotypical" activation of Leu M3+ cells at the onset of the disease and warrant future studies to evaluate the potential role of these cells in the pathogenesis of IDDM.

Effect of octreotide on growth hormone, IGF-I, IGFBP-3, glucagon, cortisol and epinephrine response to insulin-induced hypoglycaemia in insulin-dependent diabetic patients.

The purpose of the study was to investigate the effects of octreotide on the response of counterregulatory hormones to insulin-induced hypoglycaemia in 9 Type 1 diabetic patients without autonomic neuropathy. During an euglycaemic clamp, saline or octreotide (50 mcg) was randomly injected subcutaneously. Patients were then clamped to hypoglycaemic levels (2.5 mmol/l), and hormonal response was evaluated after 30 min of hypoglycaemia. Although octreotide suppressed both GH (0.5 +/- 0.01 vs 9.5 +/- 0.9 ng/ml, p < 0.001) and glucagon (110 +/- 9 vs 165 +/- 10 pg/ml, p < 0.05) responses, it did not affect cortisol, epinephrine, IGF-1 and IGFBP-3 levels. The time required for recovery from hypoglycaemia was longer after octreotide (19.1 +/- 1.2 min vs 14.3 +/- 0.9 min, p < 0.05), and a greater amount of infused glucose was needed to reach normoglycaemia (g 24.6 +/- 1.2 vs 17.7 +/- 1.3, p < 0.05). These findings suggest that administration of octreotide to insulin-treated Type 1 diabetic patients may impair anti-hypoglycaemic counterregulatory mechanisms through suppression of glucagon and GH responses.

Different effect of acute and chronic oral metformin administration on glucose and insulin response to bread and to pasta in non-insulin dependent diabetic patients.

The aim of the study was to evaluate whether acute and chronic metformin administration may influence differently the glycaemic and insulin response to foods with high and low glycaemic index (bread and pasta) in twelve non-insulin dependent diabetic (NIDDM) patients. Thirty minutes after a random oral administration of either a placebo or a single 850 mg metformin dose, glycaemic and insulin responses to 90 g white bread or 68 g pasta (corresponding to 50 g carbohydrates) were evaluated within 4 h. All the patients were subsequently treated with metformin (850 mg twice a day) for a month and then glycaemic and insulin responses were evaluated again. The acute administration of metformin lowered glycaemic response to bread at 60 and 90 min (P < 0.02 and P < 0.05, respectively) but not to pasta, without affecting insulin response. Chronic metformin treatment significantly lowered glycaemic and insulin response to both bread and pasta. In conclusion, an acute antihyperglycaemic effect of metformin was demonstrable only when a food with high glycaemic index, such as bread, was eaten. On the contrary, the effect of chronic treatment was always present, independent from the glycaemic index of foods, together with a reduction in insulin response, indicating an enhanced sensitivity to endogenous insulin.

Safety, efficacy, acceptability of a pre-filled insulin pen in diabetic patients over 60 years old.

The aim of the study was to evaluate safety, efficacy and acceptability of a pre-filled insulin pen device (NovoLet) in diabetic patients over 60 years old already treated with insulin administered with conventional syringes. After a run-in period of 2 weeks, 60 patients participated in a randomized cross-over study with two 6-week treatment periods using the insulin pen or conventional syringes. Insulin regimens did not change during the study. Hypoglycaemic episodes did not differ significantly between both kinds of treatment and no severe hypoglycaemia was registered. HbAlc (%) was (mean +/- S.D.) 7.7 +/- 1.2 and 7.9 +/- 1.1 during pen and syringe treatment, respectively. Blood glucose profiles were similar during both treatment modalities except for pre-lunch blood glucose values (mmol/l) lower during pen treatment (8.7 +/- 2.9 vs. 9.2 +/- 2.7, P < 0.01). The insulin dose (U/day) was 31.9 +/- 8.9 (pen) and 32.3 +/- 9 (syringe). 54 patients found the functioning of the insulin pen easy to understand and preferred it for future treatment because the conditions of insulin administration are faster and easier than with conventional syringes. We concluded that the pre-filled insulin pen is safe, efficacious and is highly accepted in over 60 years old diabetic patients.

Effects of octreotide on glycaemic control, glucose disposal, hepatic glucose production and counterregulatory hormones secretion in type 1 and type 2 insulin treated diabetic patients.

We studied the effects of continuous subcutaneous infusion of octreotide (100 micrograms/day for 5 days) on glycaemic values, counterregulatory hormones secretion, hepatic glucose production (HGP) and glucose disposal during an euglycaemic clamp in 7 C-peptide-negative type 1 diabetic patients and 7 C-peptide positive insulin-treated type 2 diabetic patients. In type 1, but not type 2 diabetic patients, octreotide significantly reduced glycaemic values (P < 0.005) and also diminished HGP during an euglycaemic clamp (P < 0.05). However, insulin stimulated global glucose uptake remained unchanged. GH, glucagon, IGF-I, IGFBP-3 levels, were significantly lowered by octreotide in both type 1 and type 2 diabetic patients whereas cortisol and epinephrine remained unmodified. Moreover in type 2 diabetic patients both basal (P < 0.05) and after-meal (P < 0.01) C-peptide secretion was reduced by octreotide. These data point to different metabolic effects of octreotide in type 1 versus type 2 diabetic patients with the drug only being able to reduce glycaemic values and HGP in the former but not in the latter subjects. The failure of octreotide to diminish glycaemic values and HGP in type 2 diabetic patients in spite of its ability to lower GH and glucagon may probably depend on temporary blockage of residual endogenous insulin secretion induced by octreotide administration.

A simplified diagnostic test for ambulatory screening of peripheral diabetic neuropathy.

The reliability and reproducibility of Michigan Neuropathy Screening Instrument (MNSI), a recently proposed simple test for ambulatory screening of peripheral diabetic neuropathy (PDN), was evaluated on 80 diabetic patients. MNSI was carried out by two diabetologists and repeated after a week. It consisted of the sum of scores varying from 0 to 1 for each abnormality revealed in foot appearance, achilles reflexes presence and vibratory threshold (VPT) by tuning fork (maximum score = 8). Then patients had to go to neurologist for PDN diagnosis by a quantitative neurological examination and electrophysiological evaluation, the so named Michigan Diabetic Neuropathy Score (MDNS) and the results compared with MNSI score according to one of the two observers. The inter-observer reproducibility of MNSI was 88.75% the within observer reproducibility was 95 and 94%, respectively, for each observer with good correlation between the two measurements (P < 0.001). The MNSI score of 2.5 as a cut-off appeared to be reliable for ambulatory screening of suspected PDN (false positive and false negative = 2.5%; specificity and sensitivity = 75% and 78.6%, respectively). In conclusion MNSI by using 2.5 score as cut-off may be considered a rapid, simple, reproducible and reliable test for rapid ambulatory screening of PDN from the diabetologists.

Increased urinary albumin excretion is a marker of risk for retinopathy and coronary heart disease in patients with type 2 diabetes mellitus.

The prevalence of increased urinary albumin excretion (UAE) (micro- and macroalbuminuria) and its association with diabetic retinopathy (DR) (evaluated by fluorescent angiography), coronary heart disease (CHD), and various related risk factors were studied in 320 type 2 diabetic patients. In this subsample of type 2 diabetic patients, microalbuminuria was present in 15% of the patients; macroalbuminuria in 4.8%, CHD in 9.9%, DR in 53.4%, and arterial hypertension in 46%. UAE was independently related to CHD (P < 0.05), retinopathy (P < 0.001), hypertension (P < 0.001), and triglycerides (P < 0.02). We conclude that increased UAE is associated to a greater frequency of retinopathy and CHD in type 2 diabetic patients.

Increased frequency of HCV and HBV infection in type 2 diabetic patients.

The aim of our study was to verify if the diabetic population can be considered at risk for HBV (B hepatitis virus) and/or HCV (C hepatitis virus) correlated viral hepatitis. We examined 1514 diabetic patients, 668 males and 846 females. In patients who had, on at least two occasions, pathological transaminase values (AST and/or ALT), the markers for HBV and HCV infection were determined. Of the 1514 patients studied, 295 (19.48%) had pathological values of ALT and /or AST. Among the hypertransaminase patients (295), 69 were not tested for the markers because they refused to give informed consent; of the remaining 226 patients, 54 were negative and 172 (76.6%) were positive for at least one of the hepatitis markers (HBV, HCV or both). Those who were anti-HCV positive were 115 (38.98%), of which 50 were also positive to hepatitis B (16.9%), while those positive only to the B markers were 57 (19.3%). If we compare the patients with positive markers (172) to the total number of diabetic patients studied (1514), we find that there is a hepatitis B and/or C prevalence of 11.36%, with no statistically significant difference between females (95/846, 11.23%) and males (77/668, 11.53%). The prevalence of only hepatitis C was 7.6%, while only hepatitis B was 7.1%. In conclusion, our study shows an increasing prevalence of hepatitis C and B, often associated, in type 2 diabetic patients that allows us to define them as a group at risk for viral hepatitis.

Effect of octreotide on insulin requirement, hepatic glucose production, growth hormone, glucagon and c-peptide levels in type 2 diabetic patients with chronic renal failure or normal renal function.

Aim of this study was to investigate whether octreotide, a synthetic somatostatin analogue that inhibits growth hormone, insulin and glucagon secretion and improves glycaemic control in insulin dependent diabetic patients was able to exert similar effects in insulin treated type 2 diabetic patients with chronic renal failure who have high plasma glucagon levels. For this purpose saline or octreotide was randomly administered by continuous subcutaneous infusion (100 mcg/daily) in addition to usual insulin treatment for 5 days to six type 2 insulin treated diabetic patients with chronic renal failure and to six type 2 patients with normal renal function, as a control group. At day 3 of insulin plus saline or insulin plus octreotide treatment, total glucose uptake and hepatic glucose production (HGP) were investigated during an euglycemic clamp; at day 5 GH, glucagon and C-peptide plasma levels were evaluated. Octreotide treatment lowered endogenous insulin secretion (evaluated by C-Peptide levels assay), GH and glucagon in all patients, but caused a significant reduction of daily insulin requirement (32 +/- 14 I.U. vs 41 +/- 19 I.U., P<0.02) only in patients with renal failure. HGP was significantly (P<0.05) lowered in patients with renal failure but glucose uptake remained unchanged. The lowering effect of octreotide on insulin requirement in diabetic patients with renal failure in spite of the contemporaneous inhibition on insulin secretion could be explained on the basis of the greater reduction of glucagon levels which are very elevated in these patients as compared to patients with normal renal function. The lowering of glucagon could decrease HGP and, consequently, insulin requirement.

Frequency of coronary heart disease and related risk factors in a diabetic and nondiabetic population: a comparative study.

The aim of the study was to evaluate the frequency of Coronary Heart Disease (CHD) and some related risk factors since as hyperlipidemia, hypertension, obesity and visceral distribution of adipose tissue on 733 type 2 diabetic patients in ambulatory care compared to 3500 nondiabetic subjects, matched for age and sex. The frequency of CHD, hyperlipidemias, hypertension, obesity and visceral distribution of adipose tissue was significantly higher in diabetic than in nondiabetic subjects. The risk for CHD was greater in diabetic vs nondiabetic women (4.22) as compared to diabetic vs nondiabetic men (2.6). CHD was mostly associated (over 50% of cases) with hypertension, hyperlipidemia and visceral distribution of adipose tissue. Both cholesterol and triglyceride values, such as CHD frequency, were higher in diabetic patients with poor glycemic control with respect to those with acceptable glycemic, especially in women.

Diabetic neuropathy: prevalence, concordance between clinical and electrophysiological testing and impact of risk factors.

UNLABELLED: The aim of this study was to assess the prevalence of various forms of diabetic neuropathy (DN), by clinical and electrophysiological tests, on 374 diabetic patients (66 with type 1 and 308 with type 2 diabetes mellitus) and the concordance between clinical and electroneurological alterations and relative risk factors impact. The overall prevalence of DN, according to the Saint Antonio Conference criteria, was 44.9% (28.88% somatic, 14.44% mixed and 1.60% autonomic) without statistical difference between type 2 and type 1 diabetes (46.43% and 37.88% respectively). In 32.24% of patients nerve conduction velocity (NCV) abnormalities were present together with clinical signs or symptoms of neuropathy, while 12.68% presented only signs and/or symptoms. In addition 9.36% of patients showed alterations of NCV in the absence of clinical signs or symptoms of neuropathy. The most frequent form was asymptomatic (30.21%), followed by symptomatic neuropathy (12.83%); rare was the severe neuropathy. Relative risk increased for diabetes duration > 20 years (p < 0.0001). IN CONCLUSION: 1) the Saint Antonio Consensus Conference criteria can be considered the most complete test for neuropathy diagnosis; 2) NCV alterations may not be concordant with signs-symptoms of neuropathy; 3) the duration of diabetes seems to be the most important risk factor.

Hypertension and related risk factors in type 2 diabetes mellitus.

METHODS: The correlation between hypertension and related risk factors has been studied in 733 type 2 diabetic patients. Hypertension was more frequent in women (65.35%) than in men (50.35%) (p < 0.0001). RESULTS: Hypertensive patients showed older age (p < 0.0001) and greater Body Mass Index (BMI) (p < 0.03) than normotensive. In the diabetic group on diet only basal insulinaemia was higher (p < 0.05) in hypertensive than in normotensive diabetic men, but not in women. Such a difference, was not seen in patients of both sexes treated with oral hypoglycaemic agents; besides there was no difference in fasting C-peptide levels between hypertensive and normotensive insulin treated patients. In both sexes hypertension was independently correlated with age, BMI, increased urinary albumin excretion, triglycerides. The strongest correlation was with the family history of hypertension. On the contrary there was no correlation between hypertension and waist-hip ratio. CONCLUSIONS: In conclusion, the association between hypertension and type 2 diabetes depends on various risk factors, but a relationship with insulin levels is not surely demonstrable.

Importance of premeal injection time in insulin therapy: Humalog Mix25 is convenient for improved post-prandial glycemic control in type 2 diabetic patients with Italian dietary habits.

We investigated the use, in a short period, of Humalog Mix25 (Mix25) in a twice-daily administration regimen compared to a twice-daily injection therapy with Humulin 30/70 (30/70) in diabetic patients with Italian dietary habits. We studied 33 type 2 diabetic patients aged 59.1 +/- 8.1 years, BMI 29.8 +/- 2.7 kg/m2, duration of diabetes and insulin therapy of 14.4 +/- 9.8 and 4.2 +/- 4.6 years, respectively. After a 4-day lead-in period of twice-daily human insulin 30/70 treatment, patients were randomized to one of two treatment sequences: (1) a twice-daily regimen with Mix25 just 5 minutes before the morning and evening meals for 12 days, followed by a twice-daily therapy with human insulin 30/70 given 30 minutes before the morning and evening meals for an additional 12 days; or (2) the alternate sequence. Each patient underwent a mixed meal test: Humulin 30/70 was administered 30 minutes before the meal, while Mix25 was given 5 minutes before. The 2-hour post-prandial glucose concentration after breakfast was significantly lower during treatment with Mix25 than with Humulin 30/70 (157 +/- 43.2 vs. 180 +/- 43.2 mg/dl, p<0.05). The glycemic excursion after dinner on Mix25 treatment was significantly lower than with Humulin 30/70 (12.2 +/- 48.01 vs. 35.5 +/- 36.92 mg/dl, p<0.05). AUCglucose after Mix25 was lower than after Humulin 30/70. Glycemia after test meal was significantly lower with Mix25 than with Humulin 30/70. Insulin and free insulin concentrations after the test meal were significantly higher with Mix25 in comparison to Humulin 30/70. AUC serum insulin and free insulin curves after Mix25 were significantly higher than after Humulin 30/70 (p=0.028 and p=0.005, respectively). Twice-daily injections of Humalog Mix25, compared to human insulin 30/70 in type 2 diabetic patients with Italian dietary habits, provide improved and lasting post-prandial glycemic control, with the great convenience of the injection just before the meal.

[Advances in insulin treatment. Evaluation of isophane or lente insulin, mixed with rapid insulin and injected twice-a-day]. / Attualità in tema di terapia insulinica. Studio sull'impiego di insuline isofano o lenta, miscelate con pronta ed iniettate due volte al giorno.

When mixed with lente insulin, regular insulin undergoes a slowing down in its absorption rate, which does not occur when it is mixed with isophane insulin. However, there is not sufficient evidence to state that this phenomenon affects the quality of the metabolic control in subjects treated with two daily mixtures of regular + intermediate insulins. This parallel study compared in a 12-month follow-up the results achieved in 154 insulin-dependent diabetics (IDD) treated with extemporary mixtures injected before breakfast and dinner, with the purpose of verifying whether the mixture regular + isophane offers specific advantages compared to regular + lente. The 79 IDD who have used isophane insulin and the 75 IDD treated with lente insulin had similar personal and clinical findings. During the 12-month study, the improvement of glucose profile, the number and the severity of hypoglycaemic episodes as well as the insulin requirement resulted almost overlapping with the two treatments. In conclusion, the results of this study confirm that the mixtures of regular + isophane insulins (Actrapid HM + Protaphane HM) and regular + lente insulins (Actrapid HM + Monotard HM) give the same guaranties of safety and efficacy, that the former shows a more rapid absorption rate and, finally, indicate that the ratio 30:70 between regular and intermediate insulins is that more frequently used.

[Effect of octreotide on blood glucose levels in poorly compensated insulin-dependent diabetics on insulin treatment]. / Effetti dell'octreotide sui livelli glicemici in diabetici insulino-dipendenti mal compensati con trattamento insulinico.

The metabolic effects of a long-acting somatostatin analogue, octreotide, in type I diabetic patients on conventional insulin therapy have been evaluated. Octreotide has been administered by subcutaneous continuous infusion employing a minipump; in 10 patients the infusion was performed from 08.00 a.m. to 08.00 p.m. and in 7 patients from 08.00 p.m. to 08.00 a.m. In both groups the drug dose was 50 mcg/12h and before starting the infusion an additional dose of 12.5 mg was rapidly injected s.c. In a third group of 8 patients octreotide was administered at a dosage of 50 mcg by subcutaneous injections at 07.00 a.m.; 3.00 p.m.; 11.00 p.m. A significant reduction of glucose levels was obtained in all patients and the results observed by minipump or by multiple injections were superimposable. It is to note that the daily drug dose employed by minipump was smaller. The evaluation of octreotide usefulness, in addition to conventional insulin therapy, in the management of type I diabetic patients, needs further extensive studies.

[Comparative study of the efficiency of ultralente insulin and NPH insulin combined with sulfonylurea in type 2 diabetes patients with secondary tolerance to sulfonylurea. Possible selection criteria]. / Studio comparato tra l'efficacia dell'insulina ultralenta e dell'insulina NPH in associazione alle sulfoniluree in pazienti diabetici di tipo 2 con fallimento secondario alle sulfoniluree. Possibili criteri di scelta.

The treatment of NIDDM patients with secondary failure to sulfonylureas is still a debated problem. In this study we compared in NIDDM patients with secondary failure to glyburide, the effect of adding a single, low-dose bed time either NPH or ultralent insulin injection (0.15-0.2 U/kg) to the previously ineffective sulfonylurea treatment. Both NPH and ultralent insulin therapy have been demonstrated to be effective in ameliorating metabolic control in NIDDM patients with secondary failure to sulfonylureas. However, the addition of bed-time ultralent insulin caused a greater and significant decrease in post prandial plasma glucose. In contrast, the average fasting plasma glucose decrease was significantly greater after NPH insulin administration. These results indicate that in NIDDM patients with secondary failure to glyburide bed-time ultralent insulin administration is a better tool to improve the post prandial plasma glucose.