Abstract
Background. The concurrent use of a postprandial insulin sensitizing agent, such as bromocriptine-QR, a quick release formulation of bromocriptine, a dopamine D2 receptor agonist, may offer a strategy to improve glycemic control and limit/reduce insulin requirement in type 2 diabetes (T2DM) patients on high-dose insulin. This open label pilot study evaluated this potential utility of bromocriptine-QR. Methods. Ten T2DM subjects on metformin (1-2 gm/day) and high-dose (TDID ≥ 65 U/day) basal-bolus insulin were enrolled to receive once daily (morning) bromocriptine-QR (1.6–4.8 mg/day) for 24 weeks. Subjects with at least one postbaseline HbA1c measurement (N = 8) were analyzed for change from baseline HbA1c, TDID, and postprandial glucose area under the curve of a four-hour mixed meal tolerance test (MMTT). Results. Compared to the baseline, average HbA1c decreased 1.76% (9.74 ± 0.56 to 7.98 ± 0.36, P = 0.01), average TDID decreased 27% (199 ± 33 to 147 ± 31, P = 0.009), and MMTT AUC60–240 decreased 32% (P = 0.04) over the treatment period. The decline in HbA1c and TDID was observed at 8 weeks and sustained over the remaining 16-week study duration. Conclusion. In this study, bromocriptine-QR therapy improved glycemic control and meal tolerance while reducing insulin requirement in T2DM subjects poorly controlled on high-dose insulin therapy.
Highlights
Maintenance of good glycemic control in type 2 diabetes mellitus (T2DM) patients typically becomes progressively more difficult as the duration of disease lengthens as a result of continuing decline in the capacity of the pancreatic beta cells for appropriate glucose stimulated insulin release, in the presence of insulin resistance [1, 2]
While hyperglycemia in patients with T2DM may be initially managed with oral antidiabetes medications alone, added insulin therapy often becomes necessary with longer duration of disease
While insulin is an effective treatment for hyperglycemia, it carries the potential for undesirable side effects such as hypoglycemia and weight gain, which in turn can lead to a worsening ability to manage diabetes [3,4,5,6,7,8]
Summary
Maintenance of good glycemic control in type 2 diabetes mellitus (T2DM) patients typically becomes progressively more difficult as the duration of disease lengthens as a result of continuing decline in the capacity of the pancreatic beta cells for appropriate glucose stimulated insulin release, in the presence of insulin resistance [1, 2]. The concurrent use of a postprandial insulin sensitizing agent, such as bromocriptine-QR, a quick release formulation of bromocriptine, a dopamine D2 receptor agonist, may offer a strategy to improve glycemic control and limit/reduce insulin requirement in type 2 diabetes (T2DM) patients on high-dose insulin. This open label pilot study evaluated this potential utility of bromocriptine-QR. Bromocriptine-QR therapy improved glycemic control and meal tolerance while reducing insulin requirement in T2DM subjects poorly controlled on high-dose insulin therapy
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