Article

Comparison of vildagliptin-metformin and glimepiride-metformin treatments in type 2 diabetic patients.

Department of Internal Medicine, Chungbuk National University, Cheongju, Korea.
Diabetes & metabolism journal 10/2011; 35(5):529-35. DOI: 10.4093/dmj.2011.35.5.529
Source: PubMed

ABSTRACT The present study investigated the efficacy and safety of vildagliptin-metformin treatment compared to those of glimepiride-metformin treatment for type 2 diabetes.
In a randomized, open-label, comparative study, 106 patients with type 2 diabetes were enrolled. The primary endpoint was a reduction in HbA1c from baseline and secondary endpoints included fasting plasma glucose (FPG) or 2-hour postprandial glucose (2h-PPG) reduction from baseline, as well as HbA1c responder rate and HbA1c reduction according to baseline HbA1c category.
Comparable HbA1c reduction was observed with a mean±standard deviation change from baseline to the 32-week endpoint of -0.94±1.15% in the vildagliptin group and -1.00±1.32% in the glimepiride group. A similar reduction in 2h-PPG (vildagliptin group 3.53±4.11 mmol/L vs. the glimepiride group 3.72±4.17 mmol/L) was demonstrated, and the decrements in FPG (vildagliptin group 1.54±2.41 mmol/L vs. glimepiride group 2.16±2.51 mmol/L) were not different between groups. The proportion of patients who achieved an HbA1c less than 7% at week 32 was 50.1% in the vildagliptin group and 56.0% in the glimepiride group. An average body weight gain of 2.53±1.21 kg in the glimepiride group was observed in contrast with the 0.23±0.69 kg weight gain noted in the vildagliptin group. A 10-fold lower incidence of hypoglycemia was demonstrated in the vildagliptin group, in addition to an absence of severe hypoglycemia.
Vildagliptin-metformin treatment provided blood glucose control efficacy comparable to that of glimepiride-metformin treatment and resulted in better adverse event profiles with lower risks of hypoglycemia and weight gain.

4 Bookmarks
 · 
684 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives to evaluate the effects of vildagliptin compared to glimepiride on glycemic control, insulin resistance and post-prandial lipemia. Material and Methods 167 type 2 diabetic patients, not adequately controlled by metformin, were randomized to vildagliptin 50 mg twice a day or glimepiride 2 mg three times a day for 6 months, in a double blind, randomized clinical trial. We evaluated: body mass index (BMI), glycemic control, fasting plasma insulin (FPI), homeostasis model assessment insulin resistance index (HOMA-IR), fasting plasma proinsulin (FPPr), glucagon, lipid profile, resistin, retinol binding protein-4 (RBP-4), visfatin and vaspin. Furthermore, at the randomization and at the end of the study all patients underwent an euglycemic hyperinsulinemic clamp to evaluate M value and an oral fat load. Results despite a similar decrease of glycated hemoglobin, there was an increase of body weight with glimepiride + metformin and a decrease with vildagliptin + metformin. Fasting plasma insulin increased with glimepiride + metformin, while it did not change with vildagliptin + metformin. Vildagliptin + metformin improved lipid profile. Regarding insulin sensitivity, vildagliptin + metformin increased M value. Resistin, RBP-4, vaspin and visfatin were decreased by vildagliptin + metformin, but in group to group comparison, only vaspin reduction resulted statistically significant. Vildagliptin + metformin reduced post-prandial lipemia and insulinemia compared to glimepiride + metformin. Conclusion vildagliptin, in addition to metformin, was more effective than glimepiride + metformin in reducing insulin resistance and post-prandial lipemia.
    Metabolism. 01/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: To analyze the glycemic response of Indian Patients with Type2 diabetes mellitus to combination therapy of vildagliptin and metformin and compare our data with that of clinical trials. In a retrospective study of hospital database, the glycemic control of 280 patients with type 2 diabetes mellitus who were either on an once daily or a twice daily combination therapy of Vildagliptin 50 mg and metformin 500 mg was analyzed. The mean duration of follow-up of the patients was 16.8 months. There was a reduction of fasting plasma glucose (FPG) of 1.52 ± 0.79 mmol/l (p < 0.0001) in the once daily group and 1.88 ± 0.87 mmol/l (p < 0.0001) in the twice daily group, from baseline to last visit. The reduction of post-prandial plasma glucose (PPPG) was 3.98 ± 1.72 mmol/l (p < 0.0001) in the once-daily group and that in the twice daily group was 4.33 ± 1.88 mmol/l (p < 0.0001). The reduction in HbA1c was 1.41 ± 1.39% (p < 0.0001) in the once daily group, whereas, in the twice daily group the same was 1.90 ± 1.49% (p < 0.0001). The differences in FPG and HbA1c reduction by the two dosage regimens were statistically significant. Although this retrospective study showed a robust response to vildagliptin and metformin combination in Indian patients, more multi-center studies from India with greater number patients will be necessary to confirm this finding.
    Journal of Diabetes 07/2013; · 2.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Dipeptidyl peptidase-IV (DPP-4) inhibitors and sulphonylureas are two important second-line anti-diabetic agents. The objective of this research was to evaluate the efficacy and safety of DPP-4 inhibitors compared with sulphonlyureas by meta-analytic approach of available randomized studies. We searched MEDLINE, EMBASE, and the Cochrone Central Register of Controlled Trials databases up to 30 June 2013 collecting all randomized clinical trials with a treatment duration ≥ 18 weeks. Data on glycated haemoglobin(HbA1c), body weight, hypoglycemia, total adverse events and cardiovascular events were retrieved and analyzed. The analysis included 12 randomized studies comprising 10,982 patients with type 2 diabetes mellitus (T2DM). Based on meta-analysis, sulphonylureas lowered HbA1c significantly more than DPP-4 inhibitors with weighted mean difference (WMD) of 0.105(95% Confidence Interval, CI, 0.103 to 0.107). The results were consistent in trials with longer(>32 weeks) or shorter(≤32 weeks) duration; however, DPP-4 inhibitors showed greater reduction in HbA1c compared to the second generation sulphonylureas and in patients with baseline eGFR < 50 mL/min/1.73 m(2) . Patients treated with DPP-4 inhibitors are less likely to achieve HbA1c < 7% compared with sulphonylureas(Mantel-Haenszel odds ratio, MH-OR, 0.91; 95%CI 0.84 to 0.99). DPP-4 inhibitors was associated with a reduction in body weight(WMD -1.652; 95%CI -1.658 to -1.646), and lower risk of hypoglycemia(MH-OR, 0.13; 95%CI 0.11 to 0.16), total adverse events(MH-OR, 0.79; 95%CI 0.72 to 0.87) and cardiovascular events(MH-OR, 0.53; 95%CI 0.32 to 0.87) compared to sulphonylureas. Although compared to sulphonylureas, DPP-4 inhibitors is less efficacious, it demonstrates a beneficial effect on body weight, episode of hypoglycemia, and total adverse events. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 10/2013; · 2.97 Impact Factor

Full-text

View
27 Downloads
Available from