![Sample our Bioscience journals, sign in here to start your access, Latest two full volumes FREE to you for 14 days]({"type":"image" , "src" : "/sda/5925/TOC-Subject-Sample-2021-Bioscience.jpg"})
ABSTRACT
Background: Insulin resistance and declining β-cell function are the core defects in type2 diabetes mellitus. It has been suggestedthat deteriorating glycemic control is relatedto baseline hemoglobin A1c (HbA1c) values andremaining β-cell function.
Patients and methods: We report glycemic data from a 3.5‐year, open-label, observational, primary care study comparing 30 mg/day pioglitazone with 3.5 mg/day glibenclamide add-on to stable metformin monotherapy in 500 patients with type 2 diabetes. Insulin commencement was considered for patients with HbA1c ≥ 8.0% or when vascular complications occurred. The change in HbA1c compared with baseline and the difference in time to failure to maintain glycemic control were calculated.
Results: At endpoint, HbA1c had decreased by 1.0% in the pioglitazone group ( p < 0.005) and by 0.6% in the glibenclamide group ( p < 0.05). Annual progression rates to insulin treatment were 6.6% (pioglitazone) and 16.4% (glibenclamide; p < 0.001 between-group difference). Mean weight increases of 3.5 ± 0.42 kg in the pioglitazone group and 3.3 ± 0.38 kg in the glibenclamide group were noted. Overall, both treatments were well tolerated.
Conclusions: Pioglitazone add-on to metformin revealed significant benefits in long-term glycemic control compared with glibenclamide. This difference may be explained by a large between-group difference in HOMA-S, which was shown to correlate significantly to the change in HbA1c. This suggests that a strategy to reduce insulin resistance to lower the burden of the β‐cell is superior to treatment with glibenclamide.
Notes
* Data from this study have been presented as a poster at the Diabetes Technology Society Annual Scientific Meeting in San Francisco, USA, November 10-12, 2005