TITLE:
Effects of long-term monotherapy with glimepiride vs glibenclamide on glycemic control and macrovascular events in Japanese Type 2 diabetic patients
AUTHORS:
Hirohisa Onuma, Kouichi Inukai, Masaki Watanabe, Yoshikazu Sumitani, Toshio Hosaka, Hitoshi Ishida
KEYWORDS:
Glibenclamide; Glimepiride; Macrovascular Events; HOMA-R/β
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.4 No.1,
January
20,
2014
ABSTRACT: We investigated
whether long-term glimepiride (GP) monotherapy improves insulin resistance and
exerts a beneficial effect on beta cell function, as compared with
glibenclamide (GC). One hundred Japanese Type 2 diabetic patients were randomly
assigned to the GP (n = 50) or the GC (n = 50) group. During a 5-year
monitoring period, patients received the indicated SU monotherapy, while
changes in SU doses were allowed as needed to maintain HbA1C below 7.0%. The GC
group, in parallel with fasting insulin, showed a rapid homeostatic model
assessment (HOMA)-R increase and maintained a high HOMA-R level. In contrast,
HOMA-R in the GP group decreased continuously, from 2.9 at baseline to 1.8 at
study completion. In the GC group, HOMA-b was markedly increased in the first 6 months, then gradually decreased through 18 months. While the HOMA-β elevation
in the GP group was more moderate than that in the GC group, HOMA-β levels were maintained with a slight
decrease. The cumulative macrovascular disease outcome was 1 for the GP and 7
for the GC group, showing a significant difference. These results suggest that
glimepiride monotherapy markedly improved HOMA-R with moderate insulin
stimulation, which may account for the difference in macrovascular disease development
as compared with the group receiving glibenclamide.