Adding to the treatment toolkit: glimepiride therapy after 10+ years with type 2 diabetes

This study examined the use of the sulphonylurea glimepiride (Amaryl) in patients with long-standing (10 or more years) type 2 diabetes mellitus.

Patients with type 2 diabetes mellitus either do not produce enough or are not sensitive to insulin, the hormone which helps the body break down the glucose (sugar) that is taken in from food. Type 2 diabetes is a progressive disease, in that the beta cells (cells in the pancreas that produce and release insulin) steadily decrease in function over time. Therefore, more than one type of therapy is needed over the course of the disease.

Therapies for type 2 diabetes include sulphonylureas, medications that increase the production of insulin. Previous studies have found that insulin stimulating therapies are helpful in controlling blood glucose levels even in long-term type 2 diabetes patients who are no longer producing insulin.

The current study examined the effectiveness of the sulphonylurea glimepiride (Amaryl) on glycemic (blood glucose) control in long-term (10 or more years) type 2 diabetes patients. 43 patients were included in the study. All had been treated with insulin and metformin (Glucophage, a medication that increases sensitivity to insulin and decreases glucose production by the liver) for at least one year. Patients were randomly assigned to receive glimepiride for 12 weeks followed by a placebo (a substance that has no effect on the body) for 12 weeks, or the reverse; placebo followed by glimepiride. HbA1c levels (a measure of average blood glucose levels over 3 months), c-peptide levels (an indication of beta-cell function), and incidences of hypoglycemia (dangerously low blood glucose levels) were measured.

During placebo, no changes were seen in HbA1c. During glimepiride treatment, there was an average HbA1c decrease of 0.6%, a significant decrease from the levels at the start of the study. Insulin doses also had to be decreased in 53.5% of patients.

C-peptide measures did not change during the placebo period, but increased significantly during the glimepiride treatment.

No severe hypoglycemia episodes were seen during the study. Minor hypoglycemia was seen in 51% of patients. Of these episodes, 74% occurred during glimepiride treatment.

This study concluded that treatments that increase insulin production, such as glimepiride (Amaryl), can still effectively help to lower blood glucose in patients with long-standing (10 or more years) type 2 diabetes mellitus.