Combination Therapy in NIDDM

The use of a combination of oral hypoglycemic drugs and insulin to treat patients with non-insulin-dependent diabetes mellitus (NIDDM) that is refractory to treatment with oral hypoglycemic drugs alone has long been of great interest to practitioners. I cannot remember when I last gave a lecture on diabetes without being asked my opinion of the merits of combination therapy. Combination therapy makes good pathophysiologic sense. NIDDM has two main pathophysiologic features: relative insulin deficiency¹ and decreased peripheral and hepatic sensitivity to insulin.² The combination of a sulfonylurea drug that increases insulin sensitivity³ and exogenous insulin should theoretically correct both defects…