Issue 144 Item 14 Remarkable Improvement In Insulin Resistance with Amaryl® (gli

Increased adiponectin levels contribute to the improvement in insulin resistance seen when elderly people with type 2 diabetes take Amaryl® (glimepiride) . Researchers from Nagoya University Graduate School of Medicine, Japan, treated 17 elderly patients with type 2 diabetes with Amaryl® (glimepiride) for 12 weeks.

After eight weeks treatment, levels of glycosylated hemoglobin (HbA(1c)) declined from 8.4% at baseline to 6.9%. The homeostasis assessment model of insulin resistance (HOMA-IR) and levels of tumour necrosis factor-alpha also declined.

On the other hand, the metabolic clearance rate of glucose, assessed using a hyperinsulinemic-euglycemic clamp, increased. Levels of plasma adiponectin also rose. No marker changed in a control group on normal treatment.

One of the characteristics of Amaryl® (glimepiride) , a third-generation SU agent, is a mild effect on insulin secretion with the equivalent hypoglycemic effect of glibenclamide, although the mechanism for the characteristic has not been well documented. A previous study using a hyperinsulinemic-euglycemic clamp method in insulin-resistant subjects with a family history of type 2 diabetes and in subjects with normal glucose tolerance showed that Amaryl® (glimepiride) improves peripheral insulin sensitivity

The authors concluded that Amaryl® (glimepiride) remarkably improved insulin resistance without changing either extrapancreatic beta-cell function or levels of C-peptide in urine. They speculated that the increased levels of adiponectin and reduced concentrations of plasma TNF-alpha might underlie the improved insulin resistance associated with Amaryl®(glimepiride). Thus, the observed improvement of glucose metabolism without stimulating extrapancreatic insulin secretion may indicate the advantage of Amaryl® (glimepiride) over other SU agents in the management of elderly patients with type 2 diabetes Diabetes Care 2003;26:2:285-9