Metformin Plus Low-Dose Glimeperide Significantly Improves Homeostasis Model Assessment for Insulin Resistance (HOMAIR) and [beta]-Cell Function (HOMA[beta]-cell) Without Hyperinsulinemia in Patients With Type 2 Diabetes Mellitus.
Bermudez-Pirela, Valmore J MD 1*; Cano, Climaco PhD 1; Medina, Mayerlim T MD 1; Souki, Aida MgSc 1; Lemus, Miguel A MD 1; Leal, Elliuz M MD 1; Seyfi, Hamid A MD 1; Cano, Raquel MD 1; Ciscek, Ana MD 1; Bermudez-Arias, Fernando MD 1; Contreras, Freddy MD 2; Israili, Zafar H PhD 3; Hernandez-Hernandez, Rafael MD 4; Valasco, Manuel MD 2
[Article]
American Journal of Therapeutics.
14(2):194-202, March/April 2007.
(Format: HTML, PDF)
Objective: Type 2 diabetes mellitus is characterized by insulin resistance and defects in insulin secretion from pancreatic [beta]-cells, which have been studied by using euglycemic/hyperinsulinemic clamps. However, it is difficult to study insulin resistance and [beta]-cell failure by these techniques in humans. Therefore, the aim of this study was to evaluate the effect of three different antidiabetic therapeutic regimens on insulin resistance and [beta]-cell activity by using a mathematical model, Homeostasis Model Assessment for insulin resistance (HOMAIR) and [beta]-cell function (HOMA[beta]-cell).
Research design and methods: Seventy type 2 diabetic patients were randomly assigned to one of three therapeutic regimens: (A) metformin American Diabetic Association (ADA)-recommended diet physical activity; (B) metformin low-dose glimepiride ADA diet physical activity; or (C) ADA diet physical activity (no drugs). Blood samples were obtained before and after the treatment to determine serum levels of fasting and post-prandial blood glucose, fasting insulin, and glycosylated hemoglobin (HbA1c), and HOMAIR and HOMA[beta]-cell were calculated.
Results: Fasting and post-prandial levels of glucose, HbA1c, and fasting insulin and calculated HOMAIR and HOMA[beta]-cell values before treatment were significantly higher than the respective values after treatment for all groups of patients (P < 0.01). Significant differences were also found when comparing the treatment-induced reduction in fasting blood glucose (51.8%; P < 0.01), post-prandial blood glucose (55.0%; P < 0.05), and HOMAIR (65.3%; P < 0.01) in patients of Group B with that in patients receiving other therapeutic options (Groups A and C).
Conclusions: Metformin plus low-dose glimepiride (plus ADA diet and physical activity) is a more effective treatment for type 2 diabetes than either metformin plus ADA diet and physical activity or ADA diet and physical activity alone. Determination of HOMAIR and HOMA[beta]-cell values is an inexpensive, reliable, less invasive, and less labor-intensive method than other tests to estimate insulin resistance and [beta]-cell function in patients with type 2 diabetes mellitus.
(C) 2007 Lippincott Williams & Wilkins, Inc.