Abstract
Aims
To investigate the effect on glycaemic control of adding glimepiride to on-going treatment
with metformin and insulin in patients with known diabetes more than 10 years.
Methods
Glimepiride 4 mg or placebo was added in randomised order for three months with a washout period
of 6 weeks. All insulin regimens were allowed. Insulin doses were reduced if considered
necessary. Continuous glucose monitoring was performed at the end of each period.
Results
Forty-three patients, median age 66 years (46–74), diabetes duration 16 (10–30), BMI
30 kg/m2 (25–37) and mean HbA1c 7.1% NGSP, (64 mmol/mol IFCC) were randomised. With placebo there was no change in HbA1c while a decrease of 0.6%, (7 mmol/mol IFCC) (P < 0.001), was observed with glimepiride even though insulin doses had to be reduced
in 23 patients (median change 29%, range 2–100%). Minor hypoglycaemia was reported
but no severe hypoglycaemic event was observed. The ratio between C-peptide/glucose
increased significantly (P < 0.001) with glimepiride, both fasting and postprandially and, in a stepwise multiple
regression analysis of possible predictive factors for response, a more pronounced
decrease in HbA1c was associated with the magnitude of the increment in C-peptide/glucose. Older age
was associated with a smaller response. Twenty-nine patients (67%) were defined as
responders if this was defined as an HbA1c decrease ≥0.5% (5 mmol/mol IFCC) or an insulin dose reduction ≥20%.
Conclusions
Even after long duration of diabetes, addition of glimepiride to insulin and metformin
can be effective in lowering HbA1c and/or reducing the need for exogenous insulin.
Keywords
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Article info
Publication history
Published online: January 31, 2014
Accepted:
December 30,
2013
Received in revised form:
August 20,
2013
Received:
January 9,
2013
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
