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Glimepiride Added to Insulin Regimen May Result in Better Outcomes

Added glimepiride may be better than increasing insulin doses…. 

The objective of this study was to assess the safety and efficacy of adding glimepiride to current insulin therapy in poorly controlled type 2 diabetes – as opposed to using increased insulin dosages. Researchers also evaluated changes in high-molecular weight adiponectin levels – a protein hormone which is believed to enhance insulin sensitivity – and their relationship to glycemic control.

Study participants included 56 individuals with type 2 diabetes treated with insulin. Study participants were continued on their current insulin therapy and randomly assigned to receive either glimepiride (Group A, n=29) or receive an increased dose of insulin (Group B, n=27). Glimepiride was initiated at 1 mg daily and titrated up to a maximum of 4 mg daily until the glycemic control target was attained. The glycemic target was defined as fasting blood glucose of ≤ 7.0 mmol per liter and 2-hour postprandial blood glucose ≤ 10 mmol per liter.

HbA1c values, total daily insulin dose, body weight, and the number of hypoglycemic events were recorded at weeks 0, 12 and 24 — along with lipid concentrations, serum C peptide and high molecular weight adiponectin levels measured at weeks 0 and 24.

Study participants in Group A who were considered responders – defined as a > 0.5% hbA1c lowering – were further divided into 2 sub-groups. Researchers further assessed lipids along with HbA1c and high molecular weight adiponectin levels. During the study, mean values of HbA1c, fasting blood glucose and 2-hour postprandial blood glucose were significantly reduced in both groups with greater improvements in the group A compared with individuals in group B (P < 0.01). In group A, HbA1c was reduced by an average of 2.0% from baseline compared to a 1.6% reduction in group B (P < 0.01). Target HbA1c levels were achieved in 52% of individuals in group A compared to 30% in group B (P < 0.05). In group A, high molecular weight adiponectin levels were significantly increased with adiponectin levels increasing from 3.12 mcg per mililiter to 5.86 mcg per mililiter. No significant changes in adiponectin were observed in group B. In group A, the observed changes in HbA1c were found to be inversely correlated with changes in adiponectin levels (r = −0.452, P = 0.02).After stratifying patients into subgroups according to the degree of HbA1c lowering, significantly greater increases in the high molecular weight adiponectin levels were observed in the responder group compared than in the non-responder group. At the end of study, study participants in Group A had a reduction in insulin dose by 53% (from 68.6 to 32.3 units per day), with those in Group B receiving 29% more insulin.

Practice Pearls:
  • Insulin promotes the storage of energy in the body which. in excess, may result in the undesirable side effect of weight-gain
  • The addition of glimepiride to insulin regimens, as opposed to increasing insulin doses, may result in better glycemic control along with a smaller total daily insulin dose
  • Note: sulfonylureas may adversely affect beta-cell function over time and reduce their effectiveness
  • Increases in high molecular weight adiponectin levels may be a significant contributing factor for glycemic improvements associated with glimepiride

Li CJ, Zhang JY, Yu DM, Zhang QM. Adding glimepiride to current insulin therapy increases high-molecular weight adiponectin levels to improve glycemic control in poorly controlled type 2 diabetes. Diabetol Metab Syndr. 2014;6(1):41. http://www.dmsjournal.com/content/6/1/41