Title: Comparative evaluation of Pioglitazone versus Voglibose on glycemic control in patients with Type 2 Diabetes Mellitus on Metformin

Authors: Md Faheem Mubeen, Dr Deepak Bhosle, Dr Abhijeet Bhagat, Dr Zubair Quazi

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i7.135

Abstract

Background: Type 2 Diabetes mellitus (Type 2 DM) is a heterogeneous group of disorders associated with both macrovascular and microvascular complications. Due to progressive nature of type 2 DM, dual drug therapy produces additive effects, allows the use of submaximal doses, and less side effects of individual agents. Therefore, the present study was designed to study the effect of pioglitazone in comparison to voglibose on glycemic control as an add-on drug in patients with Type 2 DM whose glycemic status was uncontrolled with metformin alone.

Methods: The present study was open, randomized parallel group comparison of two active treatment groups over a period of six months. Sixty-seven patients of either sex in the age group of 30-60 years, suffering from type 2 DM, with FBG ≥ 126 mg/dl and PPBG ≥ 200 mg/dl as per ADA were selected at randomly. The effect of pioglitazone and voglibose were observed on various parameters i.e. FBG and PPBG.

Results: At the end of 6 months it was observed that though both pioglitazone and voglibose reduced FBG and PPBG significantly but pioglitazone caused a significantly greater percentage change in FBG but voglibose caused a significantly greater percentage change in PPBG. Few side effects were observed with voglibose and not with pioglitazone.

Conclusions: Though pioglitazone and voglibose were equally effective in lowering Blood glucose levels yet pioglitazone showed better results in improving FBG, as compared to voglibose. Furthermore, voglibose presented better results in controlling PPBG, as compared to Pioglitazone. Pioglitazone had minimal side effects as compared to voglibose.

Keywords: Diabetes mellitus, Voglibose, Pioglitazone.

References

  1. Reaven GM, Role of insulin resistance in human disease. Diabetes; 1988; 37: 1595–607
  2. Peter H, Troels KH, Lise T, Steffen T, Rudi S, Allan F, Hans-Henrik. Mannose-Binding Lectin as a Predictor of Microalbuminuria in Type 1 Diabetes. Diabetes 2005, 54:1523.1527. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2004;27: 5-10.
  3. CDC diabetes. National Diabetes Fact Sheet, general information. CDC Division of Diabetes Translation Public Inquiries/Publications, US 2005.
  4. Joshi SR, Parikh RM. India - diabetes capital of the world: now heading towards hypertension. J Assoc Physicians India. 2007;55:323–4.
  5. Kumar A, Goel MK, Jain RB, Khanna P, Chaudhary V. India towards diabetes control: Key issues. Australas Med J. 2013;6(10):524–31.
  6. Anjana RM, Ali MK, Pradeepa R, Deepa M, Datta M, Unnikrishnan R, Rema M, Mohan V. The need for obtaining accurate nationwide estimates of diabetes prevalence in India - rationale for a national study on diabetes. Indian J Med Res. 2011;133:369–80.
  7. National Heart, Lung, and Blood Institute; National Institute of Diabetes and Digestive and Kidney Diseases.Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report. Bethesda, MD: National Institutes of Health; 1998. NIH Publication No. 98-4083. Chapter 2, part C: Overweight and obesity: background, Health risks of overweight and obesity.
  8. Tachibana K, Yamasaki D, Ishimoto K, Doi T. The role of PPARs in cancer. PPAR Res 2008;10:27-37
  9. Yki-Ja¨rvinen H. Thiazolidinediones. N Engl J Med 2004; 351 (11): 1106-18
  10. Walter H, Lubben G. Potential role of oral thiazolidinedione therapy in preserving β-cell function in type 2 diabetes mellitus. Drugs 2005; 65 (1): 1-13.
  11. Diani AR, Sawada G, Wyse B, et al. Pioglitazone preserves pancreatic islet structure and insulin secretory function in three murine models of type 2 diabetes. Am J Physiol Endocrinol Metab 2004; 286 (1): 116-22.
  12. Martindale, The Complete Drug Reference, Pharmaceutical Press, Part 3: 334.
  13. Abhishek Raj. Formulation and In-vitro evaluation of Voglibose Dispersible EJBPS, 2016;3(2): 226-30.
  14. American Diabetes Association. Standards of medical care in diabetes2014. Diabetes Care. 2014; 37 (1): S14-80.
  15. Liu W, Yang XJ: The Effect of Metformin on Adolescents with Type 1 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Endocrinol 2016;385:40-71.
  16. Pernicova I, Korbonits M. Metforminmode of action and clinical implications for diabetes and cancer. Nat Rev Endocrinol. 2014; 10: 143-56.
  17. Maida A., Lamont BJ., Caox, Drucker DJ., Metformin regulates the incretin receptors axis via a pathway dependent on peroxisome proliferator-activated receptors alpha in mice. Diabetologia. 2011;54: 339-49.
  18. Costa B, Pinol C. Acarbose in ambulatory treatment of non-insulin-dependent diabetes mellitus associated to imminent sulfonylurea failure: a randomised-multicentric trial in primary health-care. Diabetes and Acarbose Research Group. Diabetes Res Clin Pract 1997; 38:33-40.
  19. Shinozaki K, Suzuki M, Hirose J, Hara Y, Harano Y. Improvement of insulin sensitivity and dyslipidemia with a new glucosidase inhibitor, Voglibose in nondiabetic hyperinsulinemic subjects. Metabolism 1996;45:731-7.
  20. Olansky L, Marchatti A, Lau H. Multicenter retrospective assessment of thiazolidinedione monotherapy and combination therapy in patients with type 2 diabetes mellitus: comparative subgroup analyses of glycaemic control and blood lipid levels. Clin Ther 2003;25 Suppl B:B64-80.
  21. Boyle PJ, King AB, Olansky L, Marchetti A, Lau H, Magar R et al. Effects of pioglitazone and rosiglitazone on blood lipid levels and glycemic control in patients with type 2 diabetes mellitus: a retrospective review of randomly selected medical records. Clin Ther 2002;24:378-96.
  22. Goldberg RB, Kandall DM, Deeg MA, Buse JB, Zagor AJ, Pinaire JA et al. A comparison of lipid and glycemic effects of pioglitazone and rosiglitazone in patients with type 2 diabetes mellitus and dyslipidemia. Diabetes Care 2005;28: 1547-54.
  23. Mughal MA, Memon MY, Zardari MK, Tanwani RK, Ali M. Effect of acarbose on glycemic control, serum lipids and lipoproteins in type 2 diabetes. J Pak Med Assoc 2000;50:152-6.
  24. Iwamoto Y, Kashiwagi A, Yamada N, Terao S, Mimori N, Suzuki M et al. Efficacy and safety of vildagliptin and voglibose in Japanese patients with type 2 diabetes; a 12 week, randomized, double blind, active controlled study. Diabetes Obes Metab 2010;12:700-8.
  25. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359 (15):1577-89.
  26. Diani AR, Sawada G, Wyse B. Pioglitazone preserves pancreatic islet structure and insulin secretory function in three murine models of type 2 diabetes. Am J Physiol Endo Metab. 2003;286:116–122.

Corresponding Author

Md Faheem Mubeen

Department of Pharmacology, MGM Medical College and Hospital, Aurangabad, India