Efficacy of Some Combination Regimens of Oral Hypoglycaemic Agents in Type 2 Diabetes Mellitus Patients

E Kumolosasi,Gb Yan,Ce Wee

doi:10.4314/tjpr.v14i7.22

Abstract

Purpose: To examine the efficacy of selected oral hypoglycaemic agent (OHA) regimens in a small group of patients receiving such treatment. Methods: This was a retrospective, observational study that involved patients who had been diagnosed with type 2 diabetes mellitus and undergoing routine follow-up at a teaching hospital. By reviewing patients’ medical records, changes in fasting blood glucose (FPG) and glycated haemoglobin (HbA1c) levels induced by several OHA cobmination regimens were documented. Target FPG and HbA1c were defined as 4.4 - 6.1 mmol/L and 6.5 %, respectively. Results: Based on the medical records of 156 patients reviewed, the combination of metformin and gliclazide was the most commonly prescribed regimen (63.46 %). The use of gliclazide + rosiglitazone + acarbose produced the greatest reduction in FPG and HbA1c (-4.80 mmol/L and -4.20 %, respectively), but the number of patients receiving this combination was too small to allow definitive conclusions to be made. More patients in the triple OHA group were able to achieve the desired glycaemic control than those in the dual OHA group (FPG, 44.44 % versus 41.18 %; HbA1c, 52.94 % versus 47.06 %), highlighting the important benefits conferred by the use of multiple OHAs. Conclusion: The efficacy of various OHA combinations varies, and adding a third drug to a dual-agent regimen further reduces FPG and HbA1c levels. Though gliclazide + rosiglitazone + acarbose produces the greatest reduction in FPG and HbA1c levels, larger studies are required to confirm these findings. Keywords: Type 2 Diabetes Mellitus, Oral Hypoglycaemic Agents, Fasting Plasma Glucose (FPG), Glycated Haemoglobin (HbA1c), Combination Therapy, Gliclazide, Rosiglitazone, Acarbose

Highlights

Oral hypoglycaemic agents (OHAs) represent an important treatment option for type 2 diabetes mellitus (DM)
Gliclazide, rosiglitazone plus acarbose induced the greatest reductions in Fasting plasma glucose (FPG) and HbA1c levels, namely - 4.80 mmol/L and - 4.20 %, respectively (Figures 2 and 3); but this regimen was rarely prescribed [given to only two patients (1.28 %)]
Analysis by independent T-test revealed that combined gliclazide, rosiglitazone and acarbose was significantly better than metformin plus gliclazide (p = 0.043) in regards to FPG control; but comparison with other regimens was not statistically significant

Summary

Introduction

Oral hypoglycaemic agents (OHAs) represent an important treatment option for type 2 diabetes mellitus (DM). Each of the OHA classes exerts its hypoglycaemic effect via a different mode of action. The major limitation of OHA monotherapy is a loss of effectiveness over time, necessitating addition of another OHA or switch to insulin therapy [2]. Where the first OHA at maximum dosage does not achieve the desired glycaemic control, a second OHA from a different class is usually added. OHAs produce additive therapeutic effects by simultaneously targeting different glucose utilisation pathways in vivo [3, 4]. Recognising the indispensable role of combined OHAs in type 2 DM, we set out to assess the efficacy of different OHA combination regimens in a small group of patients receiving such treatment

Results

Discussion

Conclusion