A combination of once daily insulin and glibenclamide therapy in patients with type 2 diabetes and secondary drug failure

Twenty eight patients with non‐insulin‐dependent diabetes mellitus (NIDDM) who were not adequately controlled with maximum doses of sulphonylureas and metformin (Group I; n=13) or with insulin injections (Group II; n=15) were treated with a combination of insulin injections in the morning and glibenclamide, a sulphonylurea, in the evening. Patients in Group I had significantly lower glycosylated haemoglobin (HbA₁) and post‐breakfast blood glucose concentrations after treatment with the combination. Similarly, HbA₁ and post‐breakfast blood glucose concentrations improved in Group II patients. Nocturnal hypoglycaemia resolved. The removal of glibenclamide from treatment in both groups resulted in a significant increase in glycosuria and abnormal fasting blood glucose concentrations. We conclude that in patients with non‐insulin‐dependent diabetes and drug failure, the institution of treatment with a combination of insulin in the morning and sulphonylurea in the evening produces adequate control of diabetes, and that the removal of the evening dose of sulphonylurea results in marked hyperglycaemia in the fasting state.