Effect of 6-month gliclazide treatment on insulin release and sensitivity to endogenous insulin in NIDDM: role of initial continuous subcutaneous insulin-induced normoglycemia

Article Abstract:

Non-insulin-dependent diabetes mellitus (NIDDM) is characterized by hyperglycemia, or elevated blood glucose levels. There seem to be a number of underlying causes of hyperglycemia in NIDDM patients, including reduced secretion of insulin by the pancreatic beta cells. Sulfonylureas are a group of drugs that have proven useful in treating NIDDM. They have been shown to stimulate pancreatic beta cells and, thus, cause increased insulin secretion, but there is conflicting evidence as to whether long-term use of these drugs results in continuous stimulation of the beta cells. This study examined the short- and long-term effects of the sulfonylurea gliclazide on insulin secretion by assessing 15 obese NIDDM patients who were recently diagnosed with the disease. Ten patients were given insulin therapy for two weeks prior to initiation of gliclazide; their glucose levels were then within the normal range (normoglycemic). This was accomplished to remove the effects of hyperglycemia on insulin secretion. The other five patients started gliclazide therapy without prior insulin treatment. Results showed that insulin therapy significantly reduced fasting blood glucose levels from 14.1 millimoles per liter (mmol/L) to 4.6 mmol/L. Glycated serum protein levels, an indicator of glycemic or blood glucose control, fell from 595 percent to 280 percent, indicating good glycemic control. After initiation of gliclazide therapy, short-term results showed that excellent glycemic control was maintained in the 10 patients who were pretreated with insulin. Excellent control was also obtained in the five patients who did not receive insulin. However, glycemic control was better in the 10 insulin-treated patients who attained an average blood glucose that was of 53 percent of the pretreatment level. The remaining five patients reached an average glucose level that was 71 percent of the pretreatment level. Insulin secretion was enhanced by drug therapy in both groups. At six-month follow-up, glycemic control was still excellent in both groups; this demonstrates that gliclazide continued to stimulate insulin secretion. The results also indicate that insulin resistance is not an important factor in NIDDM, as insulin therapy can bring about good glycemic control. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Pancreatic beta cells

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An evaluation of long-term glycemic control in non-insulin-dependent diabetes mellitus: the relevance of glycated hemoglobin

Article Abstract:

Non-insulin-dependent diabetes mellitus (NIDDM) is characterized by hyperglycemia, or elevated fasting blood glucose levels. Blood glucose levels need to be lowered in patients with NIDDM to prevent the adverse side effects associated with diabetes, including damage to small blood vessels such as those that supply the eyes and kidneys. Uncontrolled NIDDM can lead to cardiovascular disease, kidney disease, eye problems and even blindness. Long-term glycemic (blood glucose) control can be ascertained by measuring glycated hemoglobin, a type of the protein that carries oxygen in red blood cells. Gliclazide is a sulfonylurea drug used to treat NIDDM and maintain glycemic control. To assess the long-term effectiveness of glycemic control in gliclazide treatment, glycated hemoglobin levels were monitored in 36 patients who were treated with this agent for 36 to 60 months; HbA1, a type of glycated hemoglobin, was measured. Nine patients dropped out of the study before 36 months; 27 patients were assessed at 36 months of whom 21 were reevaluated at 48 months and 16 at 60 months. No major complications were observed with long-term gliclazide therapy. At 36 months, HbA1 levels were within the normal range and were significantly decreased when compared with levels prior to gliclazide treatment. These results were maintained at 48 and 60 months. Individually, normal HbA1 levels were obtained by 23 of 27 patients (85 percent) at 36 months, 18 of 21 (86 percent) at 48 months, and in 13 of 16 (81 percent) at 60 months. These results indicate that long-term gliclazide therapy is effective in treating NIDDM. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Glycosylated hemoglobin

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