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Targeting postprandial blood glucose concentrations reduced haemoglobin A1c concentrations in type 2 diabetes mellitus
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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, …

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