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Issue 166 item 4 Glimepiride (Amaryl®) Provides Glycemic Control and Weight Loss

Once daily glimepiride dosages provide effective glycemic control and result in weight neutralizing or reducing effects in patients with Type 2 diabetes.

Sulphonylurea compounds induce pancreatic beta cells to secrete insulin and have been used in OAD therapy since the 1950s. However, there are several disadvantages associated with sulphonylurea treatment, including weight gain and patient non-compliance due to multiple daily dose requirements.

Glimepiride is a new, well-tolerated sulphonylurea that appears to have a number of benefits over older compounds, including once daily dosage, rapid onset, longer duration of action, and more effective maintenance of lower insulin levels in conditions of low blood glucose.

Raimund Weitgasser, MD, of St. Johanns Spital-Salzburg General Hospital, Salzburg, Austria, and colleagues conducted an open, uncontrolled study to monitor the efficacy and safety of glimepiride under routine conditions in patients with Type 2 diabetes.

Glimepiride was administered once daily at a dose of 0.5 to 4 mg to 284 patients with a mean age of 65 years (123 males) for a period ranging from 4 months to 1.5 years. The drug was substituted as treatment for patients taking other sulphonylureas and added to the treatment regimen for patients taking metformin.

According to Dr. Weitgasser, glimepiride therapy resulted in reduced levels of hemoglobin A1c (HbA1c) and body weight at all time points relative to baseline. Mean intra-individual decreases for HbA1c compared with baseline (8.4%) were 1.4%, 1.5%, and 1.7% after 4 months, 1, and 1.5 years, respectively. For body weight, the decreases were 1.9 kg, 2.9 kg and 3.0 kg compared with baseline (79.8 kg).

In addition, the researchers report that higher body mass index (BMI), greater age, and monotherapy correlated with HbA1c reduction, whereas male gender, lower age and higher BMI predicted body weight reduction.

Sulphonylureas have a variable degree of blood glucose decreasing activity that is independent of their insulin secretion stimulating activity, and the researchers suggest that, "the weight neutralizing effects of glimepiride could be due to the greater extra-pancreatic activity."

They conclude that, in addition to dosing advantages and extra-pancreatic effects, "glimepiride has a stable weight neutral or even weight reducing effect in most patients with Type 2 diabetes." They add, "This could prove advantageous for its use as a modern glucose lowering agent."
Diabetes Res Clin Pract 2003 Jul;61:1:13-9.

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