Title: A Comparison of Effect of Metformin in Combination with Glimepiride and Glibenclamide on Glycaemic Control in Patients with Type 2 Diabetes Mellitus

Authors: Ujwala Gawali*, Amruta Umathe

 DOI:  http://dx.doi.org/10.18535/jmscr/v3i8.57

DIDS : 08.2015-XXXXXXX

Abstract

ObjectiveTo compare the effects of combination therapy using metformin and glimepiride with  metformin and  glibenclamide  combination on glycaemic control (HbA1c and plasma glucose) and lipid profiles { Total cholesterol  (TC), Triglyceride  (TG), low density lipoprotein cholesterol (LDL-C),High density lipoprotein cholesterol –(HDL-C) } in type 2 diabetes mellitus  patients who have inadequately control with metformin and glibenclamide  monotherapy.

Research Design and MethodsPatients with type 2 diabetes mellitus,inadequately controlled with metformin and glibenclamide monotherapy were enrolled in the study. Eligible patients were randomized in to two groups to receive combination of metformin plus glimepiride (1000mg+2mg) and metformin  plus glibenclamide (1000mg+10mg) for 12 weeks .Primary efficacy end points were changes in fasting blood sugar (FBS) and postprandial blood sugar (PPBS) from baseline to 4weeks, 8weeks and 12weeks and changes in HbA1C  from baseline to final assessment i.e. at 12 weeks. The secondary efficacy end point included changes in lipid profile from baseline to final assessment.

Results At the end of 12 weeks difference in reduction in fasting blood sugar( FBS) and Glycosylated haemoglobin (HbA1c)between the treatment groups was not statistically significant (p>0.05).But reduction in  postprandial blood sugar (PPBS) was  statistically more significant in glimepiride and  metformin  group (p<0.05).Changes in lipid profile parameter  between the treatment groups not statistically significant. Both groups were well tolerated except hypoglycaemic events was more in glibenclamide and metformin combination group

Conclusion Both groups have similar effect on FBS and HbA1C, whereas glimepiride and metformin combination therapy has superior effect on PPBS level reduction and significantly lesser incidence of hypoglycaemia. Increasing evidence support the importance of postprandial hyperglycaemia in glycaemic control with regard to the development of complications in the patients with diabetes. Data also indicates that postprandial hyperglycaemia may have greater effect on the development of cardiovascular complications compared with elevated fasting plasma glucose.

A more intensive approach by using metformin and glimepiride combination therapy in patients with type 2 diabetes mellitus inadequately controlled with metformin, glibenclamide monotherapy  may improve the care of patients with diabetes and, ultimately,the outcome of these patients. 

Key words: combination therapy,type 2diabetes mellitus,  Metformin, glimepiride, glibenclamide.

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Corresponding Author

Ujwala Gawali

Associate Professor, Dept of Pharmacology

Dr. V.M. Government Medical College, Solapur, MH, India

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