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

Diabetology & Metabolic Syndrome

Shih-Yi Lin⁵  Wayne H-H Sheu³  Yao-Hsien Tseng¹  Shih-Te Tu²  I-Te Lee⁵  Shih-Li Su²  Wen-Jane Lee⁴  Shi-Dou Lin²  Jun-Sing Wang¹  Yi-Ting Tsai⁶  Po-Hsun Chen¹ 

[1] Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Sect. 4, Taiwan Boulevard, Taichung 40705, Taiwan;Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan;Institute of Medical Technology, College of Life Science, National Chung-Hsing University, Taichung, Taiwan;Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan;School of Medicine, College of Medicine, National Yang-Ming University, Taipei, Taiwan;Department of Internal Medicine, Taichung Veterans General Hospital, Chiayi branch, Chiayi, Taiwan

关键词: Metformin;    Glycemic control;    Glycated hemoglobin;    Disposition index;    Beta-cell function;   

Others  :  802263
DOI  :  10.1186/1758-5996-6-68

 received in 2014-02-20, accepted in 2014-05-26,  发布年份 2014

【 摘 要 】

Background

This study aimed to explore parameters which will predict good control of HbA_1c 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 [HbA_1c] 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 HbA_1c (p = 0.001) in all subjects. The addition of glibenclamide and acarbose improved HbA_1c 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 HbA_1c and DI₁₂₀ independently predicted reduction of HbA_1c as well as final HbA_1c 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 HbA_1c 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.

【 授权许可】

   
2014 Chen et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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