A Comparison of Effect of Metformin in Combination with Glimepiride and Glibenclamide on Glycaemic Control in Patients with Type 2 Diabetes

ObjectiveTo compare the effects of combination therapy using metformin and glimepiride with metformin and glibenclamide combination on glycaemic control (HbA1c and plasma glucose) and lipid profiles { Total cholesterol (TC), Triglyceride (TG), low density lipoprotein cholesterol (LDL-C),High density lipoprotein cholesterol (HDL-C) } in type 2 diabetes mellitus patients who have inadequately control with metformin and glibenclamide monotherapy. Research Design and Methods Patients with type 2 diabetes mellitus, inadequately controlled with metformin and glibenclamide monotherapy were enrolled in the study. Eligible patients were randomized into two groups to receive combination of metformin plus glimepiride (1000mg+2mg) and metformin plus glibenclamide (1000mg+10mg) for 12 weeks .Primary efficacy end points were changes in fasting blood sugar (FBS) and postprandial blood sugar (PPBS) from baseline to 4weeks, 8weeks and 12weeks and changes in HbA1C from baseline to final assessment i.e. at 12 weeks. The secondary efficacy end point included changes in lipid profile from baseline to final assessment. Results At the end of 12 weeks difference in reduction in fasting blood sugar( FBS) and Glycosylated haemoglobin (HbA1c)between the treatment groups was not statistically significant (p>0.05).But reduction in postprandial blood sugar (PPBS) was statistically more significant in glimepiride and metformin group (p<0.05).Changes in lipid profile parameter between the treatment groups not statistically significant. Both groups were well tolerated except hypoglycaemic events was more in glibenclamide and metformin combination group Conclusion Both groups have similar effect on FBS and HbA1C, whereas glimepiride and metformin combination therapy has superior effect on PPBS level reduction and significantly lesser incidence of hypoglycaemia. Increasing evidence support the importance of postprandial hyperglycaemia in glycaemic control with regard to the development of complications in the patients with diabetes. Data also indicates that postprandial hyperglycaemia may have greater effect on the development of cardiovascular complications compared with elevated fasting plasma glucose. A more intensive approach by using metformin and glimepiride combination therapy in patients with type 2 diabetes mellitus inadequately controlled with metformin, glibenclamide monotherapy may improve the care of patients with diabetes and, ultimately,the outcome of these patients.