Endocrine Abstracts

Background and aims: Metformin is the drug of first choice in obese patients with type 2 diabetes (T2DM), but in some patients it is not possible to achieve good glycaemic control by using metformin only. Starting from a fact that T2DM is a heterogeneous disorder due to the interaction of impaired early insulin secretion and peripheral insulin resistance, the aim of the present study was to evaluate and compare the efficacy of repaglinide vs. glimepirid on glycaemic control of overweight and obese patients with T2DM, previously treated by metformin.

Materials and methods: 30 overweight and obese T2DM patients, BMI 29±3 kg/m², diabetes duration 5±2.3 years, HbA1c 8,5±1.1%. All patients were at metformin therapy, metformin dose 2000 mg/day. Half of them were treated with metformin (2000 mg/day) + repaglinide (2 mg/meal) and the others were treated with metformin (2000 mg/day) + glimepirid (3 mg/day). Duration of the study was 3 months. Parameters assessed were HbA1c, FPG, blood glucose profile, change in body weight and hypoglycaemic episodes.

Results: HbA1c values during the study decreased in each group, but significantly lower in Rep + Met group 7.3 (0.1%), vs 7.9 (0.1%), P=0.03. FPG, preprandial and postprandial glycaemia decreased during the study in both groups, but postprandial glycaemia was significantly lower during Rep + Met treatment. There was not significant variation in BMI. The hypoglycaemic episodes were more frequent in Glim + Met group.

Conclusion: These results indicate that combination between repaglinide and metformin has superior effect on glycaemic control, specially in controlling postprandial hyperglycaemia, compared with combination between glimepirid and metformin.