[Personal experience with combined treatment of gliclazide and insulin in patients with non-insulin-dependent diabetes (type 2) and late secondary failure of sulphonylureas].

The study was carried out on 20 patients, aged 20-60 years, with non-insulin-dependent (type 2) diabetes of 3-17 years duration and with secondary failure of sulphonylurea derivatives. In the initial run-in-period (8 weeks) the patients were treated only with insulin in a dose decreasing glycaemia in fasting state to 160 mg% (8.9 mmol/l), then during 16 weeks they received insulin and gliclazide 160-320 mg per day, and finally during the final period (8 weeks) they were transferred again to exclusive insulin therapy. The association of gliclazide with insulin resulted in better metabolic control expressed by significant decrease of basal and postprandial glycaemia and small (non-significant) decrease of serum triglycerides level--with simultaneous reduction of daily insulin requirement by 34% on the average. In this period an increase of basal and stimulated (test meal) C-peptide secretion was observed. The improvement of the metabolic state and the increased C-peptide secretion persisted also after gliclazide withdrawal (during the second period of exclusive insulin therapy), although the determined parameters were less favourable than when combined treatment was applied. The mechanism of metabolic improvement of patients with type 2 diabetes and secondary failure of sulphonylurea derivatives, which follows the addition of gliclazide to insulin, is not fully clarified. Probably it is the consequence of both, the increased secretion of endogenous insulin and the enhanced activity of this hormone in insulin-sensitive tissues.