Abstract
BackgroundHemoglobin A1c is the main treatment target for patients with type 2 diabetes. It has also been shown recently that postprandial glucose and daily glucose fluctuations affect the progression of diabetic complications and atherosclerotic damages.MethodsContinuous glucose monitoring was performed in patients with type 2 diabetes to evaluate the efficacy of repaglinide vs. glimepiride on postprandial glucose spikes and fluctuations. A total of 10 Japanese patients with type 2 diabetes treated with glimepiride monotherapy were enrolled. After observation period for 8 weeks, glimepiride was changed to repaglinide. Continuous glucose monitoring was performed whilst consuming calorie-restricted diets for two days at baseline and at the end of the 12-week trial. Blood and urine samples were collected for measurement of glucose control parameters and inflammatory and oxidative stress markers on the last day of taking either glimepiride or repaglinide.ResultsNine patients completed the trial. Although the glucose control parameters were not significantly different between glimepiride and repaglinide, the mean amplitude of glycemic excursions measured by continuous glucose monitoring was significantly reduced by changing treatment from glimepiride to repaglinide. The levels of plasminogen activator inhibitor-1, high sensitivity C-reactive protein, and urinary 8-hydoroxydeoxyguanosine were reduced significantly by repaglinide treatment.ConclusionThese results suggest that repaglinide may decrease the risk of cardiovascular disease in type 2 diabetes by minimizing glucose fluctuations thereby reducing inflammation and oxidative stress.
Highlights
Hemoglobin A1c is the main treatment target for patients with type 2 diabetes
mean amplitude of glycemic excursions (MAGE), the standard deviation (SD) of blood glucose level, mean blood glucose level, percent of hours under 3.9 mmol/L of serum glucose in 24 hours and percent of hours over 10.0 mmol/L of serum glucose in 24 hours were calculated from the glucose curve on day 3 in order to exclude the influence of the meals on the first day of continuous glucose monitoring (CGM)
We demonstrated that repaglinide improved postprandial glucose excursions and MAGE assessed by CGM following calorie-adjusted meals
Summary
Hemoglobin A1c is the main treatment target for patients with type 2 diabetes. It has been shown recently that postprandial glucose and daily glucose fluctuations affect the progression of diabetic complications and atherosclerotic damages. Inflammation and oxidative stress have emerged as important factors in atherosclerosis, and have attracted clinical attention as novel risk factors for cardiovascular diseases (CVD). Hemoglobin A1c (HbA1c) is the main target for patients with type 2 diabetes. It has been reported that activation of either inflammation or oxidative stress by postprandial hyperglycemia is an important mechanism in the pathogenesis of atherosclerosis [7]. Glucose fluctuations during postprandial periods have a more specific triggering effect on oxidative stress than chronic sustained hyperglycemia [8]. Acute glucose swings should be targeted as an anti-atherosclerotic strategy in the treatment of type 2 diabetes
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