Combined Sulfonylurea Research Articles

INTERACTIONS OF METFORMIN AND OTHER MEDICATIONS IN REDUCING THE ODDS OF AGE-RELATED MACULAR DEGENERATION IN A COHORT OF PATIENTS WITH DIABETES.

A previous study from our group demonstrated protective effects of the use of metformin in the odds of developing age-related macular degeneration (AMD). This is a subgroup analysis in a cohort of patients with diabetes to assess the interaction of metformin and other medications in protecting diabetic patients against developing AMD. This is a case-control analysis using data from the Merative MarketScan Commercial and Medicare databases. Patients were 55 years and older with newly diagnosed AMD and matched to controls. We performed multivariable conditional logistic regressions, which adjusted for known risk factors of AMD and tested multiple interaction effects between metformin and 1) insulin, 2) sulfonylureas, 3) glitazones, 4) meglitinides, and 5) statins. The authors identified 81,262 diabetic cases and 79,497 diabetic controls. Metformin, insulin, and sulfonylureas demonstrated independent protective effects against AMD development. Sulfonylureas in combination with metformin demonstrated further decreased odds of AMD development compared with metformin alone. The other medication group (exenatide, sitagliptin, and pramlintide) slightly increased the odds of developing AMD when taken alone, but the combination with metformin alleviated this effect. The authors believe that their results bring them one step closer to finding an optimal effective hypoglycemic regimen that also protects against AMD development in diabetic patients.

Dipeptidyl peptidase-4 inhibitor compared with sulfonylurea in combination with metformin: cardiovascular and renal outcomes in a propensity-matched cohort study

BackgroundTo determine the impact of dipeptidyl peptidase-4 inhibitor (DPP4i) on the risk of major cardiocerebrovascular and renal outcomes compared with sulfonylurea (SU) combined with metformin in patients with type 2 diabetes from a population-based cohort.MethodsFrom a nationwide cohort in Korea (2008–2013), 23,674 patients with type 2 diabetes treated with DPP4i plus metformin or SU plus metformin were selected and matched by propensity score. Composite cardiocerebrovascular events including incident ischemic heart disease (IHD), ischemic stroke (IS), hospitalization for heart failure (HHF), and cardiocerebrovascular death, as well as renal events including incident end-stage renal disease or initiation of renal-replacement therapy were assessed by Cox proportional-hazards models.ResultsDuring a median follow-up of 19.6 months (interquartile range 7.2–36.4), 762 composite cardiocerebrovascular events and 17 end-stage renal events occurred. There was no significant difference in the risk of IHD (hazard ratio [HR], 1.00; 95% CI 0.81–1.23), IS (HR, 0.95; 95% CI 0.74–1.23), or cardiocerebrovascular death (HR, 0.74; 95% CI 0.46–1.18) in the DPP4i group compared to that in the SU group. Likewise, DPP4i therapy was not associated with the risk of end-stage renal outcomes (HR, 1.23; 95% CI 0.41–3.62). However, the risk of HHF was significantly higher in the DPP4i group than in the SU group (HR, 1.47; 95% CI 1.07–2.04).ConclusionsThis real-world database analysis showed that DPP4i therapy did not increase the overall risk of major cardiovascular and renal outcomes compared to SU therapy. However, the DPP4i-associated risk of HHF remained significant.

Prolonged hypoglycemia due to sulfonylurea in an elderly woman.

Overuse of antidiabetic medications is the most common cause of hypoglycemia in diabetic subjects. Here, we report a case of hypoglycemia associated with sulfonylurea administration. An 83-year-old female patient was admitted to the emergency department with complaints of loss of consciousness and fainting. The patient’s blood glucose level was of 33 mg/dL, and she received emergency treatment with an intravenous 10% dextrose solution. In conclusion, sulfonylureas in combination with antidiabetic therapy increase the risk of hypoglycemic events in elderly patients with renal failure. Therefore, we suggest that physicians should closely monitor these patients for hypoglycemia and, preferably, use drugs that have less hypoglycemia side effects.

A safety and tolerability profile comparison between dipeptidyl peptidase-4 inhibitors and sulfonylureas in diabetic patients: A systematic review and meta-analysis

BackgroundThe first treatment approach for type 2 diabetes mellitus is lifestyle change and metformin, but it is usually not sufficient. For some time, the anti-hyperglycemic classes of sulfonylureas and dipeptidyl peptidase-4 (DPP-4) inhibitors were considered second-line of treatment, since they show similar efficacy effect. However, the recent ADA-EASD consensus gives the preference to DPP-4 inhibitors compared to sulfonylureas, except if cost is a major problem. We performed a meta-analysis for safety and tolerability profile to comprehend which treatment has less adverse events. MethodsPUBMED and EMBASE databases were searched from inception until July 2017 to retrieve RCT studies comparing DPP-4 inhibitors and sulfonylureas treatments in adult type 2 diabetes patients. There was no language restriction. We extracted and combined data from studies comparison that reported safety profile and weight change. A random effect, meta-analytic model was applied to all calculations. Cochrane collaboration tool was used to assess quality and bias of the included studies. Trial registered with PROSPERO (CRD42017075823). FindingsOut of 1472 articles identified in our search and screened for eligibility, 36 studies comparing DPP-4 inhibitors and sulfonylureas were identified. DPP-4 inhibitors in combination with metformin had less overall adverse events (RR: 0·90; 95% CI, 0·86–0·94; p < 0·0001; I2 = 83%; 17 studies), cardiovascular events (RR: 0·54; 95% CI, 0·37–0·79; p = 0·002; I2 = 0%; 6 studies), hypoglycemia (RR: 0·17; 95% CI, 0·13–0·22; p < 0·00001; I2 = 76%; 17 studies) and severe hypoglycemic events (RR: 0·10; 95% CI, 0·05–0·19; p < 0·00001; I2 = 0%; 12 studies). The mean difference of the weight change was 1·92 kg in favor of DPP-4 inhibitors in combination with metformin in relation to sulfonylureas in combination with metformin. Monotherapy with DPP-4 inhibitors also had less rates of hypoglycemia (RR: 0·31; 95% CI, 0·24–0·41; p < 0·00001; I2 = 0%; 8 studies) and severe hypoglycemic events (RR: 0·26; 95% CI, 0·10–0·66; p = 0·004; I2 = 0%; 8 studies) and patients did not gain 1·19 kg. InterpretationThese results suggest better safety profile for DPP-4 inhibitors than sulfonylureas for both comparisons, and it is more notable when the treatment regimen includes metformin. FundingThis study was funded by Takeda Pharmaceuticals, Brazil.

The Safety Profile Comparison Between Dipeptidyl Peptidase-4 Inhibitors and Sulfonylureas in Diabetic Patients: A Systematic Review and Meta-Analysis

Background: The first treatment approach for type 2 diabetes mellitus is lifestyle change and metformin, but it is usually not enough. The anti-hyperglycemic classes of sulfonylureas and dipeptidyl peptidase-4 (DPP-4) inhibitors are considered second-line of treatment, since they show similar efficacy effect. Due to this fact, we performed a meta-analysis for safety profile to comprehend which treatment has lower adverse events. Methods: PUBMED and EMBASE databases were searched from inception until July 2017 to retrieve RCT studies comparing DPP-4 inhibitors and sulfonylureas treatments in adult type 2 diabetes patients. There was no language restriction. We extracted and combined data from studies comparison that reported safety profile and weight change. A random effect, meta-analytic model was applied in all calculations. Cochrane collaboration tool was used to assess quality and bias of the included studies. Findings: Of 1,472 articles identified in our search and screened for eligibility, 36 studies comparing DPP-4 inhibitors and sulfonylureas were identified. DPP-4 inhibitors in combination with metformin had less overall adverse events (RR: 0*90; 95% CI, 0*86-0*94; p<0*0001; I2=83%; 17 studies), cardiovascular events (RR: 0*54; 95% CI, 0*37-0*79; p=0*002; I2=0%; 6 studies), hypoglycemia (RR: 0*17; 95% CI, 0*13-0*22; p≤0*00001; I2=76%; 17 studies) and severe hypoglycemia events (RR: 0*10; 95% CI, 0*05-0*19; p≤0*00001; I2=0%; 12 studies). The mean difference of the weight change was 1*92 kg in favor of DPP-4 inhibitors in combination with metformin in relation to sulfonylureas in combination with metformin. Monotherapy with DPP-4 inhibitors also had less rates of hypoglycemia (RR: 0*31; 95% CI, 0*24-0*41; p≤0*00001; I2=0%; 8 studies) and severe hypoglycemia events (RR: 0*26; 95% CI, 0*10-0*66; p=0*004; I2=0%; 8 studies) and patients did not gain 1*19 kg. Interpretation: These results suggest better safety profile for DPP-4 inhibitors than sulfonylureas for both comparisons, and it is more notable when the treatment regimen includes metformin. Trial Registration for Meta-Analysis: Trial registered in PROSPERO (CRD42017075823). Funding Statement: This study was funded by Takeda Pharmaceuticals, Brazil. Declaration of Interests: DF reports grants from Takeda Distribuidora Ltda., during the conduct of the study. MCMF reports grants from Takeda Distribuidora Ltda. during the conduct of the study; he is scientific director from AxiaBio Life Sciences International, a consultancy company that provides various work to distinct healthcare stakeholders, including Takeda Distribuidora Ltda; and he is employed by Sao Paulo Federal University as professor, outside the submitted work. GML has nothing to discosure. FGE has nothing to disclosure. Ethics Approval Statement: We conducted the systematic review and meta-analysis in accordance with recommendations from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study protocol was registered in PROSPERO (CRD42017075823).

MIF/CD74 axis is a target for metformin therapy in diabetic podocytopathy - real world evidence.

202 uncontrolled type 2 diabetics, who were previously prescribed sulfonylurea monotherapy(n=100) or sulfonylurea in combination with metformin (n=102) were enrolled in the study. The amount of macrophage migration inhibitory factor(MIF) and CD74 in serum, urinary MIF to creatine ratio(UMCR), urinary CD74 to creatine ratio(UCCR), urinary albumin to creatine ratio(UACR) and urinary podocalyxin to creatine ratio (UPCR) were determined. Metabolic parameters including fasting blood glucose, postprandial 2 hours blood glucose, hemoglobin A1c, MIF and CD74 in serum were comparable between the two groups. Moreover, metformin add-on therapy showed significantly better efficacy in reducing UMCR, UCCR, UPCR and UACR in comparison with those in sulfonylurea monotherapy group, respectively. UPCR had positive correlation with UACR, UMCR and UCCR (r＝0.73, r=0.69, r=0.62, P < 0.01), respectively. Metformin could present its podocyte-protective capacity in type 2 diabetics and the underlying mechanisms may be partly attributed to its effects in suppressing MIF-CD74 axis mediated inflammatory cascade response. < p > < /p >.

Consensus Recommendations on Sulfonylurea and Sulfonylurea Combinations in the Management of Type 2 Diabetes Mellitus - International Task Force.

For decades, sulfonylureas (SUs) have been important drugs in the antidiabetic therapeutic armamentarium. They have been used as monotherapy as well as combination therapy. Focus on newer drugs and concerns about the risk of severe hypoglycemia and weight gain with some SUs have led to discussion on their safety and utility. It has to be borne in mind that the adverse events associated with SUs should not be ascribed to the whole class, as many modern SUs, such as glimepiride and gliclazide modified release, are associated with better safety profiles. Furthermore, individualization of treatment, using SUs in combination with other drugs, backed with careful monitoring and patient education, ensures maximum benefits with minimal side effects. The current guidelines, developed by experts from Africa, Asia, and the Middle East, promote the safe and smart use of SUs in combination with other glucose-lowering drugs.

Commentary on "Consensus Recommendations on Sulfonylurea and Sulfonylurea Combinations in the Management of Type 2 Diabetes Mellitus: International Task Force".

For decades, sulfonylureas (SUs) have been important drugs in the antidiabetic therapeutic armamentarium. They have been used as monotherapy as well as combination therapy. Focus on newer drugs and concerns about the risk of severe hypoglycemia and weight gain with some SUs have led to discussion on their safety and utility. It has to be borne in mind that the adverse events associated with SUs should not be ascribed to the whole class, as many modern SUs, such as glimepiride and gliclazide modified release, are associated with better safety profiles. Furthermore, individualization of treatment, using SUs in combination with other drugs, backed with careful monitoring and patient education, ensures maximum benefits with minimal side effects. The current guidelines, developed by experts from Africa, Asia, and the Middle East, promote the safe and smart use of SUs in combination with other glucose-lowering drugs.

Pattern of Onset and Risk Factors for Peripheral Oedema During Vildagliptin Use: Analysis from the Vildagliptin Prescription-Event Monitoring Study in England.

Clinical trials have identified peripheral oedema (PO) as an adverse event of vildagliptin (an oral anti-diabetic drug [OAD]). A post-marketing study (PMS) was conducted to advance the understanding of vildagliptin use and particular safety concerns identified within the risk-management plan. PMS objectives included comparing the hazards between vildagliptin monotherapy and combination therapy for selected a priori identified risks, including PO. This study was a per-protocol supplementary analysis to investigate the pattern of onset and effect of vildagliptin combination therapy on PO risk. The PMS used an observational cohort design. OAD exposure, selected risk factors and outcome data were collected from general practitioners in England regarding vildagliptin users for the 6-month period after starting treatment. Data analysis comprised univariate case/non-case analysis, time-to-onset analysis and Cox proportional hazard models to estimate hazard ratios (HR) of PO adjusting for selected patients' baseline characteristics. The study cohort included 4828 patients (median age 63years; interquartile range [IQR] 54-71), 2692 of whom were male (55.8%). The crude cumulative hazard of PO was 19.09 cases (95% confidence interval [CI] 13.54-26.10) per 1000 person-years; 50% of cases occurred during the first 34days of treatment. A significantly faster time to PO onset was observed in patients prescribed concomitant sulfonylureas versus other treatment combinations (log rank test [LRT] p=0.0365); in patients with a prior history of PO (LRT p<0.001), arrhythmia (LRT p=0.0003) or hypertension (LRT p=0.0125); and in patients aged ≥60years (LRT p=0.0047). Similarly, the case/non-case univariate analysis indicated that patients with PO were older; had a higher prevalence of a history of either arrhythmia, hypertension or PO; and frequently used a sulfonylurea in combination. In the hazard function analysis, only sex and prior PO history had a profound effect on risk of PO after starting vildagliptin. Furthermore, effect modification was observed between sex and prior PO history; in male patients of average age (62years), the HR was 12.84 (95% CI 4.96-33.23); in females, it was 1.44 (95% CI 0.32-6.40). In this planned supplementary analysis, the findings suggest that PO occurred most frequently within 1month after starting treatment with vildagliptin, and previous PO history and male sex in elderly patients were important predictors of this risk. The observation that concomitant use of a sulfonylurea may also increase PO risk early after starting treatment should be taken into consideration if prescribing OADs in combination with vildagliptin.

Comparative risk for cardiovascular diseases of dipeptidyl peptidase-4 inhibitors vs. sulfonylureas in combination with metformin: Results of a two-phase study

AimsThe aim was to assess whether the use of additional data from the Disease Management Program (DMP) diabetes mellitus type 2 to minimize the potential for residual confounding will alter the estimated risk of either myocardial infarction, ischemic stroke or heart failure in patients with type 2 diabetes using sulfonylureas compared to dipeptidyl peptidase-4 (DPP-4) inhibitors in addition to metformin based on routine health care data. MethodsWe conducted a nested two-phase case–control study using claims data of one German health insurance from 2004 to 2013 (phase 1) and data of the DMP from 2010 to 2013 (phase 2). Adjusted odds ratios (ORs) for the combined cardiovascular event myocardial infarction, ischemic stroke or heart failure were calculated using a two-phase logistic regression. ResultsPhase 1 comprised 3179 patients (289 cases; 2890 controls) and phase 2 comprised 1968 patients (168 cases; 1800 controls). We observed an adjusted OR of 0.83 for the combined cardiovascular event (95% CI: 0.61–1.13). ConclusionsWe observed a non-significantly reduced risk for cardiovascular diseases in patients using DPP-4 inhibitors compared to sulfonylureas in addition to metformin. This finding was not altered by the inclusion of additional information of the DMP in the analysis. However, due to the low power of this study, further studies are needed to reproduce our findings.

Capsule Commentary on Min et al., Comparative Effectiveness of Insulin versus Combination Sulfonylurea and Insulin: a Cohort Study of Veterans with Type 2 Diabetes: How to Escalate Therapy for Patients who Fail Sulfonylureas.

Capsule Commentary on Min et al., Comparative Effectiveness of Insulin versus Combination Sulfonylurea and Insulin: a Cohort Study of Veterans with Type 2 Diabetes: How to Escalate Therapy for Patients who Fail Sulfonylureas.

Abstract 11983: Oral Therapies for Type 2 Diabetes in Combination With Long-acting Insulin and the Risks of Myocardial Infarction and Stroke

Introduction/Hypothesis: The use of oral therapies in combination with insulin for the treatment of type 2 diabetes is common, but the cardiovascular risks or benefits are largely unknown. Among users of long-acting insulin, we conducted a population-based case-control study to evaluate the incident myocardial infarction (MI) and incident stroke risks associated with sulfonylurea and metformin use. We hypothesized that sulfonylurea use would be associated with elevated risk and metformin use with decreased risk. Methods: Cases were enrollees of Group Health Cooperative (GHC) with type 2 diabetes who used long-acting insulin at the time of diagnosis with a first MI (n=413) or first stroke (n=247) from 1995-2010. Controls (n=443) were randomly sampled GHC enrollees with type 2 diabetes who used long-acting insulin, matched to cases on age, sex, and calendar year. Sulfonylureas and metformin use was classified as current, past, or never using electronic pharmacy records. MI and stroke diagnoses and potential confounding variables were validated by medical record review. Analyses were adjusted for matching variables and cardiovascular risk factors, including smoking, duration of diabetes, blood pressure, and cholesterol. Results: Current use of sulfonylureas compared with never use was associated with a higher risk of MI (OR 1.67; 95% CI, 1.10-2.55) but not stroke (OR 1.22; 95% CI, 0.74-2.00). Current use of metformin compared with never use was associated with a lower risk of stroke (OR 0.54; 95% CI, 0.31-0.95) but not MI (OR 0.77; 95% CI 0.44-1.33). Past use of sulfonylureas and past use of metformin were not associated with either outcome. Findings were robust to sensitivity analyses that tested assumptions about eligibility criteria and medication adherence. An unmeasured confounder associated with a 2-fold increased MI risk would have to be present in 70% more current users than never users of sulfonylureas to render the sulfonylurea-MI odds ratio null. Conclusions: The use of sulfonylureas in combination with long-acting insulin may increase the risk of MI compared with insulin alone. Our study adds to a growing body of evidence that metformin may be an effective cardiovascular disease prevention therapy, even when used with insulin.

Sulfonylurea in combination with insulin is associated with increased mortality compared with a combination of insulin and metformin in a retrospective Danish nationwide study.

Individual sulfonylureas (SUs) and metformin have, in some studies, been associated with unequal hypoglycaemic, cardiovascular and mortality risks when used as monotherapy in type 2 diabetes. We investigated the outcomes in patients treated with different combinations of SUs and insulin vs a combination of metformin and insulin in a retrospective nationwide study. All Danish individuals using dual therapy with SU + insulin or metformin + insulin without prior myocardial infarction (MI) or stroke were followed from 1 January 1997 to 31 December 2009 in nationwide registries. Risks of all-cause mortality, cardiovascular death, hypoglycaemia and a composite endpoint of MI, stroke and cardiovascular death were compared. Rate ratios (RR) [95% CIs] were calculated using time-dependent multivariable Poisson regression analysis. A total of 11,081 patients used SU + insulin and 16,910 used metformin + insulin. Patients receiving metformin + insulin were younger and had less comorbidity and a longer history of glucose-lowering treatment. SU + insulin was associated with higher mortality rates compared with metformin + insulin (76-126 vs 23 per 1,000 person-years). In adjusted analyses, SU + insulin was associated with increased all-cause mortality (RR 1.81 [1.63, 2.01]), cardiovascular death (RR 1.35 [1.14, 1.60]) and the composite endpoint (RR 1.25 [1.09, 1.42]) compared with metformin + insulin. Hypoglycaemia was more frequent with SU + insulin than with metformin + insulin (17-23 vs six events per 1,000 person-years) and was associated with increased mortality (RR 2.13 [1.97, 2.37]). There were no significant differences in risk between individual SUs in combination with insulin. In combination with insulin, the use of SUs was associated with increased mortality compared with metformin. There were no significant risk differences between SUs.

Colesevelam HCl Improves Glycemic Control and Reduces LDL Cholesterol in Patients With Inadequately Controlled Type 2 Diabetes on Sulfonylurea-Based Therapy

OBJECTIVE—Hyperglycemia is a risk factor for microvascular complications and may increase the risk of cardiovascular disease in patients with type 2 diabetes. This study tested the LDL cholesterol–lowering agent colesevelam HCl (colesevelam) as a potential novel treatment for improving glycemic control in patients with type 2 diabetes on sulfonylurea-based therapy.RESEARCH DESIGN AND METHODS—A 26-week, randomized, double-blind, placebo-controlled, parallel-group, multicenter study was carried out between August 2004 and August 2006 to evaluate the efficacy and safety of colesevelam for reducing A1C in adults with type 2 diabetes whose glycemic control was inadequate (A1C 7.5–9.5%) with existing sulfonylurea monotherapy or sulfonylurea in combination with additional oral antidiabetes agents. In total, 461 patients were randomized (230 given colesevelam 3.75 g/day and 231 given placebo). The primary efficacy measurement was mean placebo-corrected change in A1C from baseline to week 26 in the intent-to-treat population (last observation carried forward).RESULTS—The least squares (LS) mean change in A1C from baseline to week 26 was −0.32% in the colesevelam group and +0.23% in the placebo group, resulting in a treatment difference of −0.54% (P < 0.001). The LS mean percent change in LDL cholesterol from baseline to week 26 was −16.1% in the colesevelam group and +0.6% in the placebo group, resulting in a treatment difference of −16.7% (P < 0.001). Furthermore, significant reductions in fasting plasma glucose, fructosamine, total cholesterol, non–HDL cholesterol, and apolipoprotein B were demonstrated in the colesevelam relative to placebo group at week 26.CONCLUSIONS—Colesevelam improved glycemic control and reduced LDL cholesterol levels in patients with type 2 diabetes receiving sulfonylurea-based therapy.

Sulfonylurea therapy is associated with increased NT-proBNP levels in the treatment of type 2 diabetes

Background We sought to determine N-terminal pro-Brain Natriuretic Peptide (NTproBNP) levels among a population of individuals with type 2 diabetes, and to correlate these levels with diabetes medications and patient demographics. Methods We analyzed data from 506 patients with type 2 diabetes. We compared NT-proBNP levels of these patients with those from the general population. We also sought to determine whether patients' NT-proBNP levels were correlated with diabetes medications, age, gender, creatinine, hemoglobin A1C levels, BMI, blood pressure, and lipid levels. Results Increasing doses of sulfonylureas were associated with increasing levels of NT-proBNP. However, patients on combined sulfonylurea and metformin therapy had lower NT-proBNP levels than those on sulfonylureas alone. Neither thiazolidinediones nor insulin were associated with NT-proBNP levels. The majority of patients with type 2 diabetes had similar NT-proBNP levels compared to a reference group from the general population. In no age category did NT-proBNP levels differ significantly between men and women. Levels of NT-proBNP were positively associated with age ( p < 0.0001), systolic blood pressure ( p < 0.01) and creatinine levels ( p < 0.0001), and negatively associated with diastolic blood pressure ( p < 0.001). Levels of NT-proBNP were not associated with A1C, BMI, triglycerides, and high density lipoprotein ( p = NS). Conclusions Levels of NT-proBNP are associated with increasing sulfonylurea dosage, age, blood pressure, and creatinine levels. There is unlikely to be clinically significant differences in NT-proBNP levels between patients with type 2 diabetes and a normal population.

Diabetes Mellitus in Saudi Arabia: The Clinical Pattern and Complications in 1,000 Patients

A retrospective and prospective study of 1,000 ambulatory and hospitalized diabetic patients was done in Riyadh, Saudi Arabia. Saudis completed 777 (77.7%) and non-Saudis 223 (22.3%). Sex distribution was equal among Saudis, males 389 (50.1%) and females 388 (49.9%), but non-Saudi males were predominant at 153 (68.6%), non-Saudi females 70 (31.4%) reflecting the preponderant male expatriate labor force. A proportion of different types of diabetes was: IDDM 115 (11.7%), non-obese non-insulin dependent diabetes mellitus (NIDDM) 405 (41.0%), obese NIDDM 412 (42.1%), and early onset non-insulin dependent diabetes (diagnosis under 30 years of age), 43 (4.4%). Regarding treatment, 388 (40.6%) received insulin followed by sulfonylurea, alone in 330 (33.5%), diet only 117 (12.0%), combination sulfonylurea and biguanide in 113 (11.6%), biguanide alone in 13 (1.3%) and insulin plus tablets in 7 (0.8%). Of 472 and 426 patients, 29.7% and 30.0% had elevated total cholesterol or triglycerides respectively, while 77.2% of 373 patients had elevated glycosylated hemoglobin (HbA1). At least once in 998 patients, diabetic ketoacidosis occurred in 7.6%.