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Impact of metformin versus the prandial insulin secretagogue, repaglinide, on fasting and postprandial glucose and lipid responses in non-obese patients with type 2 diabetes

In English

Författare

  • Soren S Lund
  • Lise Tarnow
  • Merete Frandsen
  • Ulla M. Smidt
  • Oluf Pedersen
  • Hans-Henrik Parving
  • Allan Vaag

Summary, in English

Objective: Non-obese patients with type 2 diabetes (T2DM) are characterized by predominant defective insulin secretion. However, in non-obese T2DM patients, metformin, targeting insulin resistance. is non-inferior to the prandial insulin secretagogue, repaglinide, controlling overall glycaemia (HbA(1c)). Whether the same apply for postprandial glucose and lipid metabolism is unknown. Here. we compared the effect of metformin versus repaglinide on postprandial metabolism in non-obese T2DM patients. Design: Single-centre. double-masked, double-dummy. crossover study during 2 X 4 months involving 96 non-obese (body mass index:! 2 7 kg/m(2)) insulin-naive T2DM patients. At enrolment, patients stopped prior oral hypoglycaemic agents therapies and after a 1-month run-in period on diet-only treatment, patients were randomized to repaglinide (2 mg) thrice daily followed by metformin (1 g) twice daily or vice versa each during 4 months with 1-month washout between interventions. Methods: Postprandial metabolism was evaluated by a standard test meal (3 515 kJ: 54%, fat, 13% protein and 33%, carbohydrate) with blood sampling 0-6 h postprandially. Results: Fasting levels and total area under the curve (AUC) for plasma glucose, triglycerides and free fatty acids (FFA) changed equally between treatments. In contrast, fasting levels and AUC of total cholesterol. low-density lipoprotein (LDL) cholesterol, non-high-density lipoprotein (non-HDL) cholesterol and serum insulin were lower during metformin than repaglinide (mean (95% confidence intervals), LDL cholesterol difference metformin versus repaglinide: AUC: -0.17mmol/l (-0.26; -0.08)). AUC differences remained significant after adjusting for fasting levels. Conclusions: In non-obese T2DM patients, metformin reduced postprandial levels of glycaemia, triglycerides and FFA similarly compared to the prandial insulin secretagogue, repaglinide. Furthermore, metformin reduced fasting and postprandial chotesterolaemia and insulinaemia compared with repaglinide. These data support prescription of metformin as the preferred drug in non-obese patients with T2DM targeting fasting and postprandial glucose and lipid metabolism.

Publiceringsår

2008

Språk

Engelska

Sidor

35-46

Publikation/Tidskrift/Serie

European Journal of Endocrinology

Volym

158

Issue

1

Dokumenttyp

Artikel i tidskrift

Förlag

Society of the European Journal of Endocrinology

Ämne

  • Endocrinology and Diabetes

Status

Published

Forskningsgrupp

  • Genomics, Diabetes and Endocrinology

ISBN/ISSN/Övrigt

  • ISSN: 1479-683X