Comparison of the effects of gliclazide and glibenclamide on insulin resistance and metabolic parameters
Rabia Gokturk, Hayriye Esra Ataoglu, Mustafa Yenigun, Suleyman Ahbap, Zuhal Saglam, Levent Temiz, Faik Çetin, Fuat Sar & Baki Kumbasar
Introduction: It has been shown with many studies that sulphonylureas may have a negative effect on parameters of insulin resistance while improving glucose regulation. However not all of the sulphonylureas have the same effect. This analysis assessed the different effects of sulphonylureas on some metabolic parameters of insulin resistance.
Method: Newly diagnosed 25 T2DM individuals who were naive of oral antidiabetic therapy were recruited and randomized to either long lasting gliclazide (3090 mg/day;n=13) or glibenclamide (13 mg/day;n=12) group. Body-mass index (BMI), waist-hip ratio and blood pressure as well as biologic parameters like blood glucose, A1c(%), BUN, creatinine, uric acid, lipid parameters, microalbuminuria, CRP, insulin, c-peptide, glucagon, proinsulin and IGF1 levels were recorded at baseline and at the end of the third month. The ratios of glucose/insulin, proinsulin/insulin, HOMA-IR were assessed for each patient. Comparisons between groups were performed by Students t test. [Chi]2 test was used for categorical variables. All analyses were two sided with a significance level of [alpha]=0.05.
Results: By the end of three months, gliclazide caused a decrease in c-peptide and insulin levels whereas glibenclamide resulted with a significant increase. Although insulin resistance was decreased in both groups it was evident in glibenclamide group. Creatinine levels were elevated in both groups which was significant with glibenclamide group. Uric acid levels were decreased in gliclazide group contrary to glibenclamide group in which uric acid levels were elevated.
Conclusion: Sulphonylureas have different effects on metabolic parameters of insulin resistance. These data suggest that gliclazide has a lowering effect on hyperinsulinemia. Yet this study is an observation based on small number of patients, studies with bigger numbers and longer duration are required for confirmation.