Vildagliptin compared to glimepiride on post-prandial lipemia and on insulin resistance in type 2 diabetic patients.

Abstract

OBJECTIVES:

To evaluate the effects of vildagliptin compared to glimepiride on glycemic control, insulin resistance and post-prandial lipemia.

MATERIAL AND METHODS:

167 type 2 diabetic patients, not adequately controlled by metformin, were randomized to vildagliptin 50 mg twice a day or glimepiride 2 mg three times a day for 6 months, in a double blind, randomized clinical trial. We evaluated: body mass index (BMI), glycemic control, fasting plasma insulin (FPI), homeostasis model assessment insulin resistance index (HOMA-IR), fasting plasma proinsulin (FPPr), glucagon, lipid profile, resistin, retinol binding protein-4 (RBP-4), visfatin and vaspin. Furthermore, at the randomization and at the end of the study all patients underwent an euglycemic hyperinsulinemic clamp to evaluate M value and an oral fat load.

RESULTS:

Despite a similar decrease of glycated hemoglobin, there were an increase of body weight with glimepiride + metformin and a decrease with vildagliptin + metformin. Fasting plasma insulin increased with glimepiride + metformin, while it did not change with vildagliptin + metformin. Vildagliptin + metformin improved lipid profile. Regarding insulin sensitivity, vildagliptin + metformin increased M value. Resistin, RBP-4, vaspin and visfatin were decreased by vildagliptin + metformin, but in group to group comparison, only vaspin reduction resulted statistically significant. Vildagliptin + metformin reduced post-prandial lipemia and insulinemia compared to glimepiride + metformin.

CONCLUSION:

Vildagliptin, in addition to metformin, was more effective than glimepiride + metformin in reducing insulin resistance and post-prandial lipemia.

• Authors: Giuseppe Derosa, Aldo Bonaventura, Lucio Bianchi, Davide Romano, Elena Fogari, Angela D'Angelo, Pamela Maffioli
• Journal: Metabolism: clinical and experimental (Metabolism) Vol. 63 Issue 7 Pg. 957-67 (Jul 2014) ISSN: 1532-8600 [Electronic] United States
• PMID: 24874591 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Dipeptidyl-Peptidase IV Inhibitors
• Hypoglycemic Agents
• Hypolipidemic Agents
• Nitriles
• Pyrrolidines
• Sulfonylurea Compounds
• glimepiride
• Metformin
• Vildagliptin
• Adamantane

Topics

• Adamantane (adverse effects, analogs & derivatives, therapeutic use)
• Aged
• Diabetes Mellitus, Type 2 (blood, complications, drug therapy)
• Dipeptidyl-Peptidase IV Inhibitors (adverse effects, therapeutic use)
• Double-Blind Method
• Drug Therapy, Combination (adverse effects)
• Female
• Humans
• Hyperglycemia (prevention & control)
• Hyperlipidemias (complications, prevention & control)
• Hypoglycemia (chemically induced, prevention & control)
• Hypoglycemic Agents (adverse effects, therapeutic use)
• Hypolipidemic Agents (adverse effects, therapeutic use)
• Insulin Resistance
• Intention to Treat Analysis
• Male
• Metformin (adverse effects, therapeutic use)
• Middle Aged
• Nitriles (adverse effects, therapeutic use)
• Postprandial Period
• Pyrrolidines (adverse effects, therapeutic use)
• Sulfonylurea Compounds (adverse effects, therapeutic use)
• Vildagliptin
• Weight Gain (drug effects)
• Weight Loss (drug effects)