Journal ArticleDOI
secondary Failure to Treatment with Oral Antidiabetic Agents in Non-insulin-dependent Diabetes
TLDR
Impaired beta cell function is a characteristic feature of many, but not all, NIDD patients who fail on treatment with oral antidiabetic drugs, and the presence of islet cell and thyrogastric antibodies can unmask a distinct group of NIDs patients with a high risk of secondary drug failure and subsequent insulin dependency.Abstract:
To study the etiopathogenesis of secondary drug failure to treatment with oral antidiabetic agents in patients with non-insulin-dependent diabetes (NIDD) we compared 60 "nonresponders" with 60 "responders" to treatment with oral drugs. Secondary drug failure was defined as mean diurnal blood glucose greater than 12 mmol/L after an initial good response of greater than or equal to 2 yr. The nonresponders were characterized by 50% lower C-peptide concentrations than the responders (P less than 0.001). We could not, however, define a critical C-peptide level to discriminate between patients requiring and not requiring insulin therapy. There was a wide overlap of individual C-peptide values between responders and nonresponders that attenuates the clinical value of single C-peptide measurements in predicting therapy. Only by serial measurements over a period of time was it possible to achieve information about changes in beta cell function. The nonresponders showed increased frequency of islet cell (P less than 0.01), thyroid antimicrosomal (P less than 0.01), and gastric parietal cell antibodies (P less than 0.02). In nonresponders, HLA-antigen B8 was increased (P less than 0.05) and HLA-B7 decreased (P less than 0.01) compared with frequencies of responders. In conclusion, impaired beta cell function is a characteristic feature of many, but not all, NIDD patients who fail on treatment with oral antidiabetic drugs. The presence of islet cell and thyrogastric antibodies can unmask a distinct group of NIDD patients with a high risk of secondary drug failure and subsequent insulin dependency. HLA typing may further help to predict secondary failure in NIDD.read more
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Journal ArticleDOI
The clinical utility of C-peptide measurement in the care of patients with diabetes
TL;DR: C‐peptide is produced in equal amounts to insulin and is the best measure of endogenous insulin secretion in patients with diabetes and its use to assist diabetes classification and choice of treatment is reviewed.
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Oral Hypoglycemic Agents
TL;DR: This review discusses the pharmacology, mechanisms of action, and benefits and risks of oral hypoglycemic agents in patients with type 2 diabetes in the United States.
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Sulfonylureas in NIDDM
TL;DR: The effect of sulfonylurea is limited to patients with preserved β-cell function, with the best effect observed in the early stages of the disease.
Journal ArticleDOI
Latent Autoimmune Diabetes Mellitus in Adults (LADA): the Role of Antibodies to Glutamic Acid Decarboxylase in Diagnosis and Prediction of Insulin Dependency
Paul Zimmet,Tiinamaija Tuomi,Ian R Mackay,Merrill J. Rowley,William J. Knowles,Cohen M,Lang Da +6 more
TL;DR: Testing for anti‐GAD in adult‐onset non‐obese diabetic patients should be a routine procedure in order to detect latent insulin‐dependency at the earliest possible stage, since this assay can assist in the correct classification of diabetes, and more appropriate therapy.
Journal ArticleDOI
The role of sulphonylureas in the management of type 2 diabetes mellitus.
TL;DR: Sulphonylureas are particularly beneficial when combined with agents such as metformin that decrease insulin resistance and Metformin and thiazolidinediones affect insulin sensitivity by independent mechanisms.
References
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Journal ArticleDOI
Radioimmunological determination of human C-peptide in serum
TL;DR: It is suggested that displacement found with most antisera is due to substances in serum that are not related to C-peptide or proinsulin, and Serial dilutions of pancreatic extracts and sera may yield dilution curves slightly different to those of the synthetic standard.
Journal ArticleDOI
C-peptide response to glucagon. A test for the residual beta-cell function in diabetes mellitus.
O K Faber,C Binder +1 more
TL;DR: A high predictive value of the glucagon test as to how the β-cells will respond during normal daily life is indicated, as indicated by significant amounts of C-peptide in plasma.
Journal ArticleDOI
Complement-fixing islet-cell antibodies in type-i diabetes: possible monitors of active beta-cell damage
TL;DR: Investigations in type I diabetics, non-diabetic polyendocrine patients, and unaffected first-degree relatives of type I diabetic probands show that the complement-fixing islet-cell antibodies are more closely related to the onset of clinical disease than the conventional is let-cell antibody, and they tend to disappear more rapidly.
Journal ArticleDOI
Practical Clinical Value of the C-Peptide Response to Glucagon Stimulation in the Choice of Treatment in Diabetes Mellitus
Sten Madsbad,Sten Madsbad,Thure Krarup,Thure Krarup,Peter McNair,Peter McNair,Claus Christiansen,Claus Christiansen,Ole K. Faber,Ole K. Faber,Ib Transbøl,Ib Transbøl,Christian Binder,Christian Binder +13 more
TL;DR: The glucagon test seems to be of value in the outpatient clinic to discriminate non-insulin-dependent from insulin-dependent patients.
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