Is it time to re-assess the role of gliclazide? Targeting insulin resistance in type 2 diabetes patients suboptimally controlled with insulin

Abstract

Background Adult patients with type 2 diabetes controlled with insulin frequently require the addition of insulin sensitising drugs such as metformin and sometimes glitazones to achieve optimum glycaemic control. Five of a group of eight people with suboptimal diabetes control who were treated by the introduction of gliclazide are reported on. Three patients were excluded. One with type 1 diabetes and two others who had dietary or other therapeutic interventions coinciding with re-introduction gliclazide. Does the re-introduction of gliclazide effect a clinically significant improvement in glycaemic control in type 2 diabetes patients with suboptimal control taking combinations of short and long acting insulin plus metformin? Method Five adult patients with type 2 diabetes with suboptimal control using combinations of short and long acting insulin plus metformin who were adherent to their dietary regimen were treated by the addition of gliclazide at different doses. Two of the patients were taking pioglitazone in addition to metformin and insulin. Their glycaemic control was monitored over the following six months. Results All five showed significant improvement in glycaemic control after three months. Mean reduction in HbA1c was 1.4% (range 0.9% to 2.5%). Six months after the introduction of gliclazide four patients had HbA1c below base line figure and in two patients clinically significant improvement had been maintained. Conclusion A double blind randomised placebo control study is necessary to evaluate a possible role for gliclazide in type 2 diabetes patients who have suboptimal glycaemic control using combinations of short and long acting insulin plus metformin.

Accuracy of continuous nocturnal glucose monitoring after 48 and 72 hours in type 2 diabetes patients on combined oral and insulin therapy

“…Glipizide addition resulted in a rapid and substantial improvement in glycaemic control despite significant insulin dose reductions in the insulin + glipizide group. In a small, observational study the efficacy of adding gliclazide in patients in routine diabetes care, with poor glycaemic control (HbA 1c 9%; 75 mmol/mol) and treated with different insulin regimens and metformin, mean diabetes duration of 13 years, resulted in a reduction in HbA 1c of 1.4% (15 mmol/mol) after 3 months [Brown 2006]. In a Japanese study glimepiride was added to insulin in patients with a mean diabetes duration of 19 years and poor glycaemic control (JDS HbA 1c 8.4%; 74 mmol/mol) which resulted in a decrease in HbA 1c of 1.1% (12 mmol/mol) after 12 weeks, however, without significant insulin dose reductions during this period [Ose et al 2005].…”