J Korean Diabetes Assoc.  2007 Jul;31(4):336-342. 10.4093/jkda.2007.31.4.336.

Short-term Therapeutic Efficacy of Different Oral Hypoglycemic Agents Combined with Once Daily Insulin Glargine in Type 2 Diabetic Subjects with Failure of Sulfonylurea and Metformin Combination

• Hong SI
• Kim HJ
• Bae JM
• Song SO
• Park KS
• Jeon BS
• Hwang SD
• Choi JY
• Kim JH
• Kwon HJ
• Choi JS
• Woo ML
• Cho JH
• Won YJ

• KMID: 2222521
• DOI: http://doi.org/10.4093/jkda.2007.31.4.336

Abstract

Backgroud: Although the extended duration of action of insulin glargine supports a convenient once daily injection, the combination with other short acting insulins or oral hypoglycemic agents is required to control postprandial hyperglycemia in type 2 diabetes. The present study was designed to compare the short-term therapeutic efficacy of oral hypoglycemic agents with once daily insulin glargine, switching from a multiple daily injection regimen.
METHODS
After control with the intensive regimen (daily lispro insulin and glargine) during 5~7 days, 80 in-patients with type 2 diabetes were randomized and treated with four oral hypoglycemic agents (glimepiride 4 mg qd, metformin 500 mg bid, nateglinide 90 mg tid, or acarbose 100 mg tid) plus once daily insulin glargine during 5 days. Blood glucose concentration was recorded by seven daily estimations (before each meal, 2 hours after each meal, and bedtime). Blood glucose concentrations and area under the curves (AUCs) of blood glucose were compared among four groups.
RESULTS
The area under the curve of blood glucose of metformin, glimepiride, nateglinide, and acarbose groups were 165.5 +/- 46.0, 178.5 +/- 36.5, 209.9 +/- 55.1, and 224.9 +/- 55.8 mmol/L/hr respectively. Blood glucose concentrations and area under the curves of blood glucose of glimepiride and metformin groups were significantly lower than those of acarbose group. Also, those of metformin group were significantly lower than those of nateglinide group.
Conclusions
Metformin or glimepiride are more effective oral hypoglycemic agent than nateglinide or acarbose in the combination with insulin glargine in type 2 diabetic subjects with failure of sulfonylurea and metformin combination.

Keyword

Area under the curve; Blood glucose; Glargine; Hypoglycemic agents

MeSH Terms

Acarbose
Blood Glucose
Hyperglycemia
Hypoglycemic Agents*
Insulin Lispro
Insulin*
Insulins
Meals
Metformin*
Insulin Glargine
Acarbose
Blood Glucose
Hypoglycemic Agents
Insulin
Insulin Lispro
Insulins
Metformin

Figure

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  Fig. 1 Study Design. 80 Patients with type 2 diabetes were enrolled and 77 subjects completed the study. 3 patients were excluded from the study because they wanted to discontinue participating in this study. MDI, multiple daily injection.

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  Fig. 2 Average daily profiles of blood glucose in patients treated with the combinations of insulin glargine and oral hypoglycemic agents. *P < 0.05 between metformin and nateglinide group, between glimepiride and acarbose group by one-way ANOVA. †P < 0.05 between metformin and acarbose group by one-way ANOVA. Average daily profiles of blood sugar levels in patients with glimepiride 4 mg qd, metformin 500 mg bid, nateglinide 90 mg tid, or acarbose 100 mg tid combined with bedtime insulin glargine. Blood sugar was checked daily at 6 a.m., 9 a.m., midday, 3 p.m., 6 p.m., 9 p.m., and midnight.

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