Can Response to Bedtime Insulin with Daytime Sulfonylurea Be Predicted in Patients with Type 2 Diabetes Mellitus?

Abstract

Objective: To determine characteristics predictive of response in patients with Type 2 diabetes mellitus (Type 2 DM) who demonstrate good or poor blood glucose control while receiving bedtime insulin with daytime sulfonylurea (BIDS) therapy. Methods: A retrospective chart review of patients with Type 2 DM receiving BIDS therapy was performed. The criterion for responders was the mean of two consecutively obtained glycosylated hemoglobin (Hb) concentrations being less than or equal to 10.2% (HbA1c ≤7.0%). Setting: A university-affiliated diabetes specialty clinic staffed consistently by a pharmacist diabetes educator, four endocrinologists, and a pharmacotherapy specialist. Patients: Thirty-one patients with Type 2 DM who were predominantly African-American and women who had documented regular follow-up examinations for more than 12 months while receiving BIDS therapy. Data Collection and Measurements: Gender, ethnicity, height, weight, calculated body mass index, age of onset of diabetes mellitus, duration of diabetes mellitus before BIDS therapy, pre-BIDS treatment regimen, dosages of NPH insulin and glyburide, glycosylated Hb concentration, fasting blood glucose concentration, and duration of BIDS therapy were recorded. Results: There were no differences in age of onset of diabetes mellitus, duration of diabetes mellitus before BIDS was initiated, duration of therapy with BIDS, or baseline glycosylated Hb concentration between responders (n = 15) and nonresponders (n = 16). Patients in the responder group weighed less, had a lower body mass index, required smaller dosages of both glyburide and NPH insulin, and achieved a lower fasting blood glucose concentration. Conclusions: In this study population, with the exception of body mass index, there was no difference in suggested clinical characteristics of response between responders and nonresponders.