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The term ‘diabetes” includes a heterogeneous group of disorders characterised by an elevated blood glucose. The maintenance of blood glucose at normal levels depends on the integrity of the islet cells, their capacity to produce insulin in response to appropriate stimuli, the fate of insulin in the liver and at the periphery and the interplay between insulin and other hormones. Diabetes can result if the islet cells are destroyed, for example, by viruses or antigens, or are functionally imperfect and respond poorly to stimuli. These and other defects may be determined by heredity, by environmental factors or by disorders of other endocrine systems.

Forty-four diabetic patients maintained on insulin entered a doubleblind crossover trial. They were given clofibrate 2 g daily for 6 weeks, either before or after a period of 6 weeks on placebo.Clofibrate did not cause any material change in insulin requirements and there was no change in body weight. Drug tolerance was good.The mean blood glucose was significantly lowered while taking clofibrate. Plasma fibrinogen and pre-beta-lipoprotein concentrations were also significantly decreased following clofibrate therapy.

Hypoglycaemic agents were replaced by placebos in diabetic patients attending a hospital clinic. Of 62 patients observed, 43 (69%) relapsed within six months but blood sugar control remained unchanged in 19 (31%) during the period of observation.

Forty-one diabetic patients on insulin were given 100mg. of phenformin daily for six weeks, either before or after a period of six weeks of inert capsules, in a double-blind cross-over trial. Eleven patients while on phenformin noticed hypoglycaemic effects and reduced their insulin on average by almost 20% without resultant rise in blood sugar levels. Twenty-eight patients felt no untoward effects and maintained their usual insulin dose. Phenformin led to improved control of the diabetes, with a significant decrease in blood sugar levels and a significant reduction in the variability of the weekly blood sugar readings. There was no increased ketosis, no change in cholesterol, and no significant loss of weight.