Chlorpropamide

PLENARY LECTURE

DIGAMI 2: A randomised trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction: Effects on mortality at 1 year. Malmberg K, Ryden L, Efendic S, Herlitz J, Nicol P, Waldenstrom A, Wedel H, Welin L

DIGAMI 2 included a total of 1253 patients with suspected acute myocardial infarction (AMI) from 48 hospitals in Europe. Patients were randomised to one of three groups: (1) acute insulin-glucose infusion followed by insulin-based long-term glucose control (474 patients); (2) insulin-glucose infusion followed by standard glucose control (i.e., no insulin) (473 patients); or (3) routine metabolic management according to local practice (306 patients).

The primary endpoint was all-cause mortality between groups 1 and 2 according to intention-to-treat analysis, while mortality differences between groups 2 and 3 and morbidity differences served as secondary and tertiary endpoints, respectively. The mean time of follow-up was about 2 years.

Researchers found no statistical differences between the groups in terms of mortality, stroke, or second AMI. Despite the unexpected results, investigators say the data show important benefits from aggressive metabolic management following AMI in patients with diabetes.

POSTER PRESENTATION

Patients with type 2 diabetes mellitus have lower rates of nocturnal hypoglycaemia on biphasic insulin aspart (BIAsp30) than on biphasic human insulin 30 (BHI30): data from the REACH study. McNally P, Fitch M, Nelson G

This multi-centre, double-blind, randomised, two-period crossover study investigated the rates of nocturnal hypoglycaemia in patients with type 2 diabetes taking either NovoMix[R] 30 or biphasic human insulin 30 (BHI30). Continuous blood glucose monitoring (CBGM) was used to follow changes in the patients' blood glucose concentration.

During an 8-week run-in period, insulin doses were titrated until patients achieved target pre-breakfast and pre-dinner blood glucose concentrations of 5-7 mmol/L. Patients who achieved an Hb[A.sub.1c] level of 6.5-8.5% (n=145) at the end of the run-in period were randomly assigned to receive twice-daily injections of either NovoMix[R] 30 or BHI30 for a 16-week treatment period. At this point, patients were then switched to the alternative insulin for a further 16-week period.

The frequency of blood glucose readings <3.5 mmol/L was found to be lower when patients were treated with NovoMix[R] 30 compared to when they were taking BHI30, although this difference was not statistically significant (3.8% versus 4.4%, respectively; p=0.067). However, the mean frequency of nocturnal glucose concentrations <3.5 mmol/L was found to be statistically significantly lower during treatment with NovoMix[R] 30 compared with BHI30 (6.3% versus 7.8%; p=0.020). This statistically significant trend was also seen when considering nocturnal glucose readings <2.5 mmol/L.

PLENARY LECTURE

Beta-cell function in type 2 diabetes--the natural history of insulin secretion in type 2 diabetes. Matthews D

In modulating beta-cell function, the aim of the ideal agent would be to augment insulin secretion without the associated decline in beta-cell function. To date, no agents have been found which successfully achieve this. The co-efficient of failure suggests that glibenclamide may cause faster decline than chlorpropamide so not all agents have the same effect; the hunt is on for therapies which will combine the lowering of glycaemia with the preservation or augmentation of beta-cell function.

The therapeutics of insulin secretion have expanded rapidly in the last decade. A better understanding of the secretory mechanisms has resulted in a slightly stronger grasp of both the heterogeneity and the phenotypic variance of a variety of subtypes of diabetes. Modulating the GLP-1 axis is a useful therapeutic intervention and there is some hope that beta-cell failure can be slowed or even reversed.

COPYRIGHT 2004 S.B. Communications
COPYRIGHT 2004 Gale Group