RESEARCH ARTICLE


Measuring Effectiveness of Glimepiride Titration Using SMBG in Patients with Mild Type 2 Diabetes



Akio Kanazawa*, 1, Tomoaki Shimizu1, Chie Ebato1, Yuko Sakurai1, Naoki Kumashiro1, Shinya Miwa1, Takahisa Hirose1, 2, Yasushi Tanaka4, Ryuzo Kawamori1, 2, 3, Hirotaka Watada1
1 Department of Medicine, Metabolism and Endocrinology
2 Center for Therapeutic Innovations in Diabetes,
3 Center for Beta Cell Biology and Regeneration, Juntendo University School of Medicine, Tokyo, Japan.
4 Department of Internal Medicine, Division of Metabolism and Endocrinology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.Tel: 81-3-5802-1579; Fax: 81-3-3813-5996; E-mail: akana@juntendo.ac.jp


© Kanazawa et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Medicine, Metabolism and Endocrinology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.


Abstract

Glimepiride is a potent sulfonylurea agent and is widely used for type 2 diabetic patients, however, the safety and efficacy of glimepiride in patientswith fair diabetic control (HbA1c level: 6.5-7.9%) have not been investigated so far. Therefore, we investigated the safety and efficacy of glimepiride titration using self-monitoring blood glucose (SMBG) in the achievement of strict glycemic control in fairly controlled diabetic patients. Japanese type 2 diabetic patients who were diet-controlled or treated with alpha-glucosidase inhibitor ormetformin, were randomly assigned into the SMBG group with titration of glimepiride using SMBG, or the conventional therapy group (control group) without SMBG. Glimepiride was initiated at a dose of 0.5 mg/day and plasma glucose, insulin, HbA1c and glycoalbumin levels were evaluated for 6 months in both groups. The dose of glimepiride was titrated in the SMBG group according to the SMBG levels before breakfast and dinner. The mean dose of glimepiride at 6 months tended to be higher in the SMBG than the control group (1.0±0.8 vs 0.6±0.3mg/day), but not significant. At 6 months after glimepiride treatment, HbA1c levels were significantly lower than at baseline (SMBG: 7.2±0.5 vs 6.5±0.6%, n=23, P<0.01, control: 7.3±0.4 vs 6.5±0.7%, n=24, P<0.01), although they were similar at 6 months in the two groups. Only three hypoglycemic episodes were recorded among 50 subjects. We found no efficacy of glimepiride titration protocol in this study. However, glimepiride significantly improved glycemic control in fairly controlled diabetic patients without severe hypoglycemia.

Keywords: Sulfonylurea agent, SMBG, titration.