Differences between Mitiglinide/Voglibose Fixed-dose Combination and Glimepiride in Modifying Low-density Lipoprotein Heterogeneity in Japanese Type-2 Diabetic Patients: A Pilot Study

Abstract

Purpose: The purpose of this study was to compare the effects of mitiglinide/voglibose fixed-dose combination and glimepiride on low-density lipoprotein (LDL)-heterogeneity in type-2 diabetic patients with unstable glycemic control after treatment with dipeptidyl peptidase-4 (DPP-4) inhibitors. Methods: This was an open-label pilot study in which type-2 diabetic patients were randomly assigned to the mitiglinide/voglibose (fixed-dose combination of mitiglinide 10?mg and voglibose 0.2?mg, n=14) or glimepiride (0.5?mg, n=16). Results: In the glimepiride group, serum LDL cholesterol (LDL-C) and small-dense (sd) LDL levels decreased significantly (?8.5% and ?9.0%), while sd-LDL/LDL-C and an indicator of LDL-particle size, LDL-C/apoB, did not change significantly. In the mitiglinide/voglibose group, serum LDL-C levels did not change, while sd-LDL levels and sd-LDL/LDL-C decreased significantly (?8.6% and ?7.9%) and LDL-C/apoB increased significantly (5.8%). Fasting blood glucose levels tended to be reduced to a greater extent in the glimepiride group than in the mitiglinide/voglibose group (?13.9% vs. ?8.4%, p=0.08), while the rate of reduction of HbA1c levels tended to be higher in the mitiglinide/voglibose group than in the glimepiride group (?6.9% vs. ?3.4%, p=0.09), suggesting differences in fluctuating blood glucose levels between the 2 groups. Conclusion: There were differences in the effects of mitiglinide/voglibose fixed-dose combination and glimepiride in addition to DPP-4 inhibitors on LDL-metabolism, and this may be related to fluctuations in blood glucose levels after treatment with these agents.

Comparison of Glycemic Excursion Using Flash Continuous Glucose Monitoring in Patients with Type 2 Diabetes Mellitus Before and After Treatment with Voglibose

“…22,26 Voglibose has been considered safe (due to poor absorption after oral use) and effective as a monotherapy or a combination therapy. 23,[27][28][29][30][31][32][33] In one study, voglibose was found to be effective in lowering daily glycemic excursions, HbA1c, and plasma glucose levels and also in improving insulin sensitivity in T2DM patients. 34 In clinical management, physicians usually prefer to prescribe combination therapies instead of a monotherapy, particularly if the target glycemic goal is not achieved with monotherapy.…”