Abstract
High plasma glucose level, lipid profile disturbances and high plasma homocysteine (Hcy) are important risk factors for cardiovascular diseases in patients with type 2 diabetes. This study was conducted to evaluate and compare effects of glimepiride/metformin combination versus gliclazide/metformin combination on cardiovascular risk factors in type-2 diabetes mellitus (T2DM) patients. One hundred and eighty T2DM patients were randomly allocated for treatment with placebo (control), metformin (500 mg twice daily), glimepiride (3mg once daily), gliclazide (80 mg once daily), metformin plus glimepiride or metformin plus gliclazide for 3 months. We evaluated plasma levels of glucose (PG), glycated hemoglobin (HbA1C), Hcy, vitamin B12, folic acid and lipid profile before treatment and 3 months post treatment. Compared to metformin treated patients, glimepiride plus metformin induced significant reductions in: fasting plasma glucose, postprandial PG, HbA1C % and plasma Hcy level. Conversely, plasma folic acid and vitamin B12 were significantly increased. The levels of total cholesterol and triglyceride were significantly decreased; low-density lipoprotein was markedly decreased, whereas high-density lipoprotein was significantly increased and hence risk ratio was significantly decreased. Similar results but with lower values were obtained using combination of metformin plus gliclazide on glycemic control only. Combination of glimepiride with metformin was superior to gliclazide plus metformin in alleviating the cardiovascular risk factors in type 2 diabetes mellitus patients.
Highlights
Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by partial or complete insulin deficiency and / or defects in insulin action (Alberti and Zimmet, 1998).Many reports have supported the use of antidiabetic combinations with complementary mechanisms of action e.g. Sulfonylurea/ metformin, to effectively control glycemia in T2DM (DeFronzo, 1999; Erle et al, 1999; Dailey, 2003; Rendell, 2004)
The aim of this study was to compare the therapeutic effect of metformin and gliclazide versus glimepiride and metformin on glycemic control and serum levels of; HbA1C, Hcy, folate, vitamin B12, lipid profile as leading risk factor contributing for cardiovascular disorders in patients with newly diagnosed uncontrolled type 2 diabetes mellitus
The combination of gliclazide or glimepiride with metformin significantly decreased fasting plasma glucose (FPG), postprandial plasma glucose (PPG) levels and HbA1C compared to control-diabetic group and metformin monotherapy group
Summary
Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by partial or complete insulin deficiency and / or defects in insulin action (Alberti and Zimmet, 1998).Many reports have supported the use of antidiabetic combinations with complementary mechanisms of action e.g. Sulfonylurea/ metformin, to effectively control glycemia in T2DM (DeFronzo, 1999; Erle et al, 1999; Dailey, 2003; Rendell, 2004). Metformin decreases blood glucose levels by hampering liver glucose production and by sensitizing peripheral tissue to insulin Sulfonylureas such as gliclazide and glimepiride lower hyperglycemia via increasing insulin secretion (Hermann et al, 1994). Controlling hyperglycemia reduces cardiovascular risk (Cefalu, 2005; Waugh et al, 2006), there have been a great attention about utilizing sulphonylureas and metformin due to potential side effects on the heart which might induced via non specific binding of sulphonylureas to ATP sensitive potassium channel (Bell, 2006), and possible increased Hcy plasma level by metformin (Fonseca et al ., 1999; Sahin et al, 2007; Aghamohammadi et al, 2011)
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