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QUESTION: What is the comparative efficacy and safety of treatment strategies that target either fasting, premeal, or postprandial glucose concentrations in patients with type 2 diabetes mellitus that was not adequately controlled with sulfonylurea agents alone?
Design
Randomised {allocation concealed*}†, unblinded,* controlled trial with 3 months of follow up.
Setting
22 centres in the US.
Patients
135 patients (mean age 57 y, 60% men) with type 2 diabetes who had secondary sulfonylurea failure defined as initial stabilisation of glucose control for ≥6 months and a subsequent lack of glucose control using maximal sulfonylurea doses. 114 patients (84%) had complete follow up.
Intervention
Patients were allocated to 1 of 3 groups for 3 months: insulin lispro plus glyburide (L plus G group, n=41), which targeted postprandial blood glucose concentrations; metformin plus glyburide (M plus G group, …