A simple clinical approach to discriminate between "true" and "pseudo" secondary failure to oral hypoglycaemic agents.

Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9200299 Publication Model: Print Cited Medium: Print ISSN: 0940-5429 (Print) Linking ISSN: 09405429 NLM ISO Abbreviation: Acta Diabetol Subsets: MEDLINE

Publication: Berlin : Springer Verlag
Original Publication: Berlin : Springer International, c1991-

C-Peptide/*blood ; Diabetes Mellitus, Type 2/*drug therapy ; Hypoglycemic Agents/*therapeutic use ; Insulin/*blood; Analysis of Variance ; Blood Glucose/metabolism ; Body Mass Index ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/physiopathology ; Diet, Diabetic ; Female ; Glucagon ; Glycated Hemoglobin/analysis ; Humans ; Male ; Middle Aged

To discriminate between true secondary failure (TF) and pseudo-secondary failure (PF) to oral hypoglycaemic agents, we studied 34 non-obese non-insulin-dependent diabetic patients who were being treated with these drugs. Nine were in good control (GC) with oral treatment, while 25 showed apparent SF. During a controlled hospital diet, fasting blood glucose remained persistently high in 15 of these patients (TF), while in the other 10 patients it clearly improved (PF). Fasting plasma glucose (FPG) and HbA1c were higher and body mass index (BMI) was lower in TF patients than in PF patients (P less than 0.01). C-peptide concentrations differed significantly among the three groups both in the fasting state (TF 0.25 +/- 0.02 nmol/l, PF 0.70 +/- 0.03 nmol/l, GC 0.74 +/- 0.03 nmol/l; P less than 0.0001) and 6 min after glucagon injection (TF 0.50 +/- 0.04 nmol/l, PF 1.02 +/- 0.06 nmol/l, GC 1.14 +/- 0.07 nmol/l; P less than 0.0001). C-peptide and plasma insulin curves obtained after a standard mixed meal also showed significant differences (P less than 0.001). In particular, there was a statistically significant difference between GC and PF versus TF (P less than 0.05), while there was no statistical difference between PF and GC. We conclude that some patients with apparent SF can improve their metabolic control if they strictly adhere to a correct diet (PF); a single measurement of basal C-peptide concentration or examination of the C-peptide and insulin responses to a meal are useful indicators for distinguishing patients with PF from those with TF to oral hypoglycaemic agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Am J Med. 1989 Aug;87(2):183-90. (PMID: 2757059)
Diabet Med. 1988 Dec;5(9):849-55. (PMID: 2976646)
J Clin Endocrinol Metab. 1983 Dec;57(6):1198-206. (PMID: 6355139)
J Clin Endocrinol Metab. 1965 Oct;25(10 ):1375-84. (PMID: 5320561)
Diabet Med. 1988 May-Jun;5(4):328-32. (PMID: 2968880)
Diabetologia. 1975 Dec;11(6):541-8. (PMID: 1239396)
Aging (Milano). 1989;1(2):147-52. (PMID: 2488306)
Am J Med. 1987 Sep 18;83(3A):3-9. (PMID: 3307404)
Diabetes. 1962;11(Suppl):74-80. (PMID: 14018020)
Am J Med. 1984 Jul;77(1):7-17. (PMID: 6377892)
Diabetes. 1977 Jul;26(7):605-10. (PMID: 326604)
Diabetologia. 1985 May;28(5):264-8. (PMID: 3894138)
Diabetes Care. 1981 Nov-Dec;4(6):616-9. (PMID: 6751738)
Diabetes. 1962;11(Suppl):80-4. (PMID: 13934500)
Diabetes Care. 1989 Feb;12(2):83-8. (PMID: 2649329)
N Engl J Med. 1977 Apr 7;296(14):787-93. (PMID: 320484)
Acta Med Scand. 1981;210(3):153-6. (PMID: 7027749)
Diabetologia. 1989 Dec;32(12):858-63. (PMID: 2693165)
Scand J Clin Lab Invest. 1985 Nov;45(7):589-97. (PMID: 3906851)
Diabetologia. 1989 May;32(5):305-11. (PMID: 2666217)
Diabete Metab. 1989 Mar-Apr;15(2):79-84. (PMID: 2661281)
Diabetes. 1965 Feb;14:59-70. (PMID: 14256053)
Metabolism. 1988 Nov;37(11):1092-100. (PMID: 3054433)
Diabetes Care. 1983 Jul-Aug;6(4):328-33. (PMID: 6617408)
Diabetes Care. 1988 Jul-Aug;11(7):531-7. (PMID: 3203569)

0 (Blood Glucose)
0 (C-Peptide)
0 (Glycated Hemoglobin A)
0 (Hypoglycemic Agents)
0 (Insulin)
9007-92-5 (Glucagon)

Date Created: 19920101 Date Completed: 19921015 Latest Revision: 20221207

20231215

10.1007/BF00572824

1520901