Post-meal β-cell Function Predicts the Efficacy of Glycemic Control in Patients with Type 2 Diabetes Inadequately Controlled by Metformin Monotherapy After Addition of Glibenclamide or Acarbose

Overview

Journal Diabetol Metab Syndr

Publisher Biomed Central

Specialty Endocrinology

Date 2014 Jun 17

PMID 24932223

Citations 5

Authors

Po-Hsun Chen

Yi-Ting Tsai

Jun-Sing Wang

Shi-Dou Lin

Wen-Jane Lee

Shih-Li Su

I-Te Lee

Shih-Te Tu

Yao-Hsien Tseng

Wayne H-H Sheu

Shih-Yi Lin

Affiliations

Soon will be listed here.

Abstract

Background: This study aimed to explore parameters which will predict good control of HbA1c after adding a second anti-diabetic drug in patients with type 2 diabetes mellitus (T2DM) inadequately controlled with metformin monotherapy.

Methods: Fifty-one patients (M/F: 25/26, mean age: 53.7 ± 8.2 years, mean glycated hemoglobin [HbA1c] 8.4 ± 1.2%) with T2DM inadequately controlled with metformin were randomized to add-on glibenclamide or acarbose for 16 weeks. Before and after combination therapy, the subjects underwent a 2-hour liquid mixed meal tolerance test to determine insulin secretion (HOMA-β, insulinogenic index, and disposition index [DI]) and insulin sensitivity (HOMA-IR and Matsuda insulin sensitivity index).

Results: At baseline, there was a significant inverse relationship between DI120 and HbA1c (p = 0.001) in all subjects. The addition of glibenclamide and acarbose improved HbA1c significantly from 8.6 ± 1.6% to 7.4 ± 1.2% (p < 0.001), and from 8.2 ± 0.8% to 7.5 ± 0.8% (p < 0.001), respectively. In the glibenclamide group, DI120 significantly increased from 51.2 ± 24.2 to 74.9 ± 41.9 (p < 0.05), and in the acarbose group, from 62.5 ± 31.4 to 91.7 ± 36.2 (p < 0.05), respectively. Multiple regression analyses showed that both baseline HbA1c and DI120 independently predicted reduction of HbA1c as well as final HbA1c after combination therapy.

Conclusions: In patients with T2DM inadequately controlled with metformin, add-on oral anti-diabetic agent with glibenclamide or acarbose resulted in the significant HbA1c reduction and improvement of β-cell function. Subjects with greater baseline β-cell function reserve displayed better glycemic response in the combination therapy of metformin with glibenclamide or acarbose.

Trial Registration: This study was registered in the ClinicalTrials.gov with registration number of NCT00417729.

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