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Glycaemic control without weight gain in insulin requiring type 2 diabetes: 1-year results of the GAME regimen.

AbstractINTRODUCTION:
Weight gain appears to be unavoidable in patients with type 2 diabetes who are switched from oral agents to insulin therapy. Peripheral hyperinsulinism induced by the use of long-acting insulin may be the key to explain this adverse effect.
AIM:
The aim of this study was to investigate whether a regimen free of long-acting insulin can provide long-term glycaemic control without causing weight gain.
PATIENTS AND METHODS:
This is an uncontrolled, 1-year study comprising 58 patients with type 2 diabetes and secondary failure, age 30-75 years, BMI 25-35 kg/m(2), HbA1c > 7.5% and fasting C-peptide level > 0.3 mmol/l. All patients were treated with the GAME regimen, a combination of glimepiride administered at 20:00 hours for nocturnal glycaemic control, insulin aspart three times daily for meal-related glucose control and metformin.
RESULTS:
Seventy-one per cent of the patients were considered evaluable. HbA1c decreased from 10.0 +/- 0.3 to 7.4 +/- 0.1% (p < 0.001). Fifty-nine per cent reached HbA1c levels <or= 7.5%. Symptomatic nocturnal hypoglycaemia was not reported. Body weight tended to decrease during the first 3 months (-1.0 +/- 0.5 kg, p = 0.06), but then gradually rose to a value 0.8 +/- 0.5 kg higher than at baseline (p = 0.12). This is 4.4 +/- 0.6 kg less than predicted for conventional regimens employing long-acting insulin (p < 0.001).
CONCLUSION:
The GAME regimen provides long-term glycaemic control as well as stabilization of body weight in about 60% of type 2 patients presenting with secondary failure.
AuthorsH de Boer, R Keizers, M Jansen, L Verschoor, J Ruineman-Koerts
JournalDiabetes, obesity & metabolism (Diabetes Obes Metab) Vol. 8 Issue 5 Pg. 517-23 (Sep 2006) ISSN: 1462-8902 [Print] England
PMID16918586 (Publication Type: Clinical Trial, Journal Article)
Chemical References
  • Blood Glucose
  • Glycated Hemoglobin A
  • Hemoglobins
  • Hypoglycemic Agents
  • Insulin
  • Sulfonylurea Compounds
  • hemoglobin A1c protein, human
  • glimepiride
  • Metformin
  • Insulin Aspart
Topics
  • Adult
  • Aged
  • Blood Glucose (metabolism)
  • Body Mass Index
  • Diabetes Mellitus, Type 2 (blood, drug therapy, physiopathology)
  • Drug Therapy, Combination
  • Female
  • Glycated Hemoglobin
  • Hemoglobins (metabolism)
  • Humans
  • Hypoglycemic Agents (therapeutic use)
  • Insulin (analogs & derivatives, therapeutic use)
  • Insulin Aspart
  • Male
  • Metformin (therapeutic use)
  • Middle Aged
  • Sulfonylurea Compounds (therapeutic use)
  • Treatment Failure
  • Treatment Outcome
  • Weight Gain (drug effects)

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