Metformin plus low-dose glimeperide significantly improves Homeostasis Model Assessment for insulin resistance (HOMA(IR)) and beta-cell function (HOMA(beta-cell)) without hyperinsulinemia in patients with type 2 diabetes mellitus.

Abstract

OBJECTIVE:

Type 2 diabetes mellitus is characterized by insulin resistance and defects in insulin secretion from pancreatic beta-cells, which have been studied by using euglycemic/hyperinsulinemic clamps. However, it is difficult to study insulin resistance and beta-cell failure by these techniques in humans. Therefore, the aim of this study was to evaluate the effect of three different antidiabetic therapeutic regimens on insulin resistance and beta-cell activity by using a mathematical model, Homeostasis Model Assessment for insulin resistance (HOMA(IR)) and beta-cell function (HOMA(beta-cell)).

RESEARCH DESIGN AND METHODS:

Seventy type 2 diabetic patients were randomly assigned to one of three therapeutic regimens: (A) metformin + American Diabetic Association (ADA)-recommended diet + physical activity; (B) metformin + low-dose glimepiride + ADA diet + physical activity; or (C) ADA diet + physical activity (no drugs). Blood samples were obtained before and after the treatment to determine serum levels of fasting and post-prandial blood glucose, fasting insulin, and glycosylated hemoglobin (HbA1c), and HOMA(IR) and HOMA(beta-cell) were calculated.

RESULTS:

Fasting and post-prandial levels of glucose, HbA1c, and fasting insulin and calculated HOMA(IR) and HOMA(beta-cell) values before treatment were significantly higher than the respective values after treatment for all groups of patients (P < 0.01). Significant differences were also found when comparing the treatment-induced reduction in fasting blood glucose (51.8%; P < 0.01), post-prandial blood glucose (55.0%; P < 0.05), and HOMA(IR) (65.3%; P < 0.01) in patients of Group B with that in patients receiving other therapeutic options (Groups A and C).

CONCLUSIONS:

Metformin plus low-dose glimepiride (plus ADA diet and physical activity) is a more effective treatment for type 2 diabetes than either metformin plus ADA diet and physical activity or ADA diet and physical activity alone. Determination of HOMA(IR) and HOMA(beta-cell) values is an inexpensive, reliable, less invasive, and less labor-intensive method than other tests to estimate insulin resistance and beta-cell function in patients with type 2 diabetes mellitus.

• Authors: Valmore J Bermúdez-Pirela, Clímaco Cano, Mayerlim T Medina, Aida Souki, Miguel A Lemus, Elliuz M Leal, Hamid A Seyfi, Raquel Cano, Ana Ciscek, Fernando Bermúdez-Arias, Freddy Contreras, Zafar H Israili, Rafael Hernández-Hernández, Manuel Valasco
• Journal: American journal of therapeutics (Am J Ther) 2007 Mar-Apr Vol. 14 Issue 2 Pg. 194-202 ISSN: 1075-2765 [Print] United States
• PMID: 17414590 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin
• Sulfonylurea Compounds
• glimepiride
• Metformin

Topics

• Blood Glucose (analysis)
• Diabetes Mellitus, Type 2 (complications, drug therapy, therapy)
• Diet
• Drug Therapy, Combination
• Female
• Glycated Hemoglobin (analysis)
• Humans
• Hyperinsulinism (complications)
• Hypoglycemic Agents (administration & dosage, therapeutic use)
• Insulin (metabolism)
• Insulin Resistance
• Insulin-Secreting Cells (drug effects)
• Male
• Metformin (administration & dosage, therapeutic use)
• Middle Aged
• Models, Biological
• Motor Activity
• Sulfonylurea Compounds (administration & dosage, therapeutic use)