Comparison on high fiber diets basal insulin supplements and flexible insulin treatment for non insulin dependent type ii diabetics poorly controlled with sulfonylureas
Scott, A.R.; Attenborough, Y.; Peacock, I.; Fletcher, E.; Jeffcoate, W.J.; Tattersall, R.B.
British Medical Journal 297(6650): 707-710
ISSN/ISBN: 0007-1447 Accession: 005016791
Objective-To compare high fibre diet, basal insulin supplements and a regimen of insulin four times daily in non-insulin dependent (type II) diabetic patients who were poorly controlled with sulphonylureas. Design-Run in period lasting 2-3 months during which self monitoring of glucose concentration was taught, followed by six months on a high fibre diet, followed by six months' treatment with insulin in those patients who did not respond to the high fibre diet. Setting-Teaching hospital diabetic clinics. Patients-33 patients who had had diabetes for at least two years and had haemoglobin A1 concentrations over 10% despite receiving nearly maximum doses of oral hypoglycaemic agents. No absolute indications for treatments with insulin. Interventions-During the high fibre diet daily fibre intake was increased by a mean of 16 g (95% confidence interval 12 to 20 g). Twenty five patients were then started on once daily insulin. After three months 14 patients were started on four injections of insulin daily. Endpoint-Control of diabetes (haemoglobin A1 concentration .ltoreq. 10% and fasting plasma glucose concentration .ltoreq. 6 mmol/l) or completion of six months on insulin treatment. Measurements and main results-No change in weight, diet, or concentrations of fasting glucose or haemoglobin A1 occurred during run in period. During high fiber diet there were no changes in haemoglobin concentrations, but mean fasting glucose concentrations rose by 1.7 mmol/l (95% confidence interval 0.9 to 2.5, P