hyperinsulinaemia, với sự phát triển của, và làm tăng nặng thêm của, loại 2 bệnh tiểu đường (Ferrari và Weidmann 1990). Hơn nữa, có bằng chứng cho thấy rằng sự đề kháng insulin và hyperinsulinaemia thúc đẩy sự phát triển của tăng huyết áp | 160 DIABETES IN OLD AGE hyperinsulinaemia with the development of and exacerbation of Type 2 diabetes Ferrari and Weidmann 1990 . Furthermore there is evidence to suggest that insulin resistance and hyperinsulinaemia promote the development of hypertension and dyslipidaemia which in turn increases the risk of cardiovascular disease Niskanen Uusitupa and Pyos 1991 . The term syndrome X or metabolic syndrome has been applied to the clinical association of insulin resistance hypertension and increased very-low-density lipoprotein and decreased HDL dyslipidaemia Reaven 1988 . Third treatment with sulphonylureas rapaglinide or insulin is associated with hyperinsulinaemia which may promote both weight gain and paradoxically increase insulin resistance. These factors are important and should be considered when antidiabetic therapy is instituted. on sulphonylureas. In overweight patients BMI 26 kg m2 metformin was recommended assuming no contraindications were present with a sulphonyl-urea added if control remains unsatisfactory. More recently the International Diabetes Federation European region has published guidelines of diabetes care for Type 2 diabetes European Diabetes Policy group 1999 . No specific stepwise algorithm has been adopted for drug treatment leaving the choice to the individual practitioner. One of the important messages from this timely document is that regular review of treatment is essential since a deterioration in glucose control over time should be expected and this will require an increase in therapy with insulin likely to be needed in many patients after a variable period of time after diagnosis. Oral Agents Newer oral hypoglycaemic therapies are being evaluated and are discussed in detail in Chapter 15. In choosing a specific drug several factors need to be considered including renal and hepatic function coexisting disease possible drug interactions and the likelihood of producing significant hypoglycaemia. For this reason glibenclamide .
