MedWire News: Patients with Type 2 diabetes achieve better glycemic control when starting insulin therapy if they continue glimepiride treatment, Japanese researchers report.
They also note that this improved glycemic control with continued glimepiride treatment was achieved at a lower daily dose of insulin than if glimepiride was discontinued.
Although sulfonylureas can be stopped once insulin therapy is initiated, it is common practice to continue treatment as it may improve postprandial hyperglycemia.
To evaluate the effect of sulfonylureas on insulin therapy, Takahisa Hirose and co-workers (Juntendo University School of Medicine, Tokyo, Japan) compared twice-daily biphasic insulin aspart 30 (Asp30Mix) with or without glimepiride in 26 insulin-naïve Type 2 diabetes patients with a glycated hemoglobin (HbA1c) level greater than 8% on oral antidiabetes therapy.
During a 24-week screening period, individuals on any maximally or submaximally tolerated dose of a sulfonylurea, with or without metformin and/or alpha-glucosidase inhibitors, had their existing sulfonylurea therapy changed to glimepiride 3 mg/day.
After 8 weeks, once-daily Asp30Mix was started for 16 weeks. Insulin was managed using the predetermined Asp30Mix dose-adjustment algorithm.
At the start of the intervention period, the Asp30 Mix was stepped up to twice-daily injections and the 26 participants were randomly assigned to either continue or discontinue glimepiride for a further 24 weeks.
Continuing the use of glimepiride following a switch to insulin therapy was more effective in improving glycemic control than discontinuing sulfonylurea therapy. During the intervention phase, HbA1c values decreased from 8.34% to 7.37% in the continuation group, whereas they increased from 8.33% to 8.53% in the discontinuation group.
The reduction in HbA1c in the continuation group was achieved despite a lower daily insulin dose compared with the glimepiride discontinuation group.
“At the end of the study, 50% of patients in the continuation group and 8.3% of patients in the discontinuation group achieved the target HbA1C value of less than 7.0%,” write the authors in the journal Diabetes Research and Clinical Practice.
No major hypoglycemic episodes were reported and the rates of minor hypoglycemia were similar between the treatment groups. Body weight also remained similar between the treatment groups.
The authors suggest that sulfonylurea therapy should initially be continued when switching to insulin, and then tapered and discontinued.
“Further studies are needed to evaluate the long-term effects of continuation or discontinuation of glimepiride (sulfonylureas) on insulin therapy, and how to taper or when to quit sulfonylureas,” they conclude.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
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