Comparing the effects of vildagliptin and glimepiride on glucose fluctuations in patients with type 2 diabetes mellitus.

This study compared the effects of vildagliptin (Zomelis) and glimepiride (Amaryl) on the rise and fall of blood glucose levels (glucose fluctuations) in patients with type 2 diabetes mellitus (T2DM). 

Patients with T2DM do not produce enough insulin (or are resistant to insulin) necessary to properly use the glucose they take from food as energy. Therefore, their glucose levels rapidly rise in the blood after a meal. Uncontrolled hyperglycemia (high blood glucose levels) leads in time to muscle, nerve and blood vessel damage. Therefore, T2DM patients need to constantly check their blood sugar levels to help them make decisions about food intake, physical activity and medications in the management of their disease. A continuous glucose monitor (CGM) is a method that determines glucose levels on a continuous basis (every few minutes). CGM uses the fluid in and around body cells to determine glucose levels. 

Oral anti-diabetes drugs (OADs) used for the management of T2DM are often associated with blood glucose fluctuations, by lowering glucose levels too much (hypoglycemia). Glimepiride is an OAD that acts by increasing insulin release from the pancreas. However, hypoglycemia is one of the common side effects reported when using glimepiride. Vildagliptin also increases insulin release from the pancreas, but it reduces blood glucose levels by decreasing glucagon release from the pancreas as well. Glucagon is a hormone produced by the pancreas that increases blood glucose levels, thus opposing the effects of insulin. By acting on both insulin and glucagon release, vildagliptin is thought to better control blood sugar levels. This study compared the effects of glimepiride and vildagliptin on blood glucose fluctuations in patients with T2DM.

A total of 24 patients with T2DM were included in this study. All patients had been previously treated with metformin (Glucophage), which is the most common drug used to treat patients with T2DM. Patients were randomly assigned to receive either 50mg of vildagliptin twice a day or 2mg of glimepiride once a day for 5 days. CGM results showed that both vildagliptin and glimepiride reduced blood glucose after meals by 15% and 16% respectively. However, patients treated with vildagliptin had 20% less blood glucose fluctuations compared to patients treated with glimepiride. 

In summary, vildagliptin was associated with less glucose fluctuations compared to glimepiride in patients with T2DM. Therefore, vildagliptin is likely to offer more long-term benefits in terms of complications associated with T2DM.

However, this study included a very small number of participants. Also, the treatment period was very short to determine any long-term benefits of the drugs. Larger studies are needed to determine the real effects of these OADs on glucose fluctuations in T2DM patients. 

Vildagliptin is not yet approved by the U.S. FDA for the treatment of patients with T2DM.

This study was funded by Novartis, the manufacturer of vildagliptin.