Metformin plus low glimepiride doses improve significantly HOMA IR and HOMAbetaCELL without hyperinsulinemia in patients with type 2 diabetes

Abstract

Type 2 Diabetes mellitus is characterized by insulin resistance and defects in insulin secretion. These variables have been studied by the euglycemic/hyperinsulinemic clamp and MinMod, which difficult the insulin resistance and beta cell failure study in clinical practice. The aim of this study was to evaluate three different anti-diabetic therapeutic options using a mathematical model (Homeostasis model assessment, HOMA). Seventy type 2 diabetic patients were randomly assigned one of the next therapeutic options: A) Metformin + ADA Diet + Physical activity (Walk, 60 minutes/day). B) Metformin + Glimepiride + ADA Diet + Physical activity. C) Only ADA diet + Physical activity. A blood sample was taken before and after the treatment to determine basal and post-prandial blood glucose, basal insulin and HbA1c and to calculate HOMAbetacell and HOMA IR. Before treatment basal and post-prandial levels of glucose, HbA1c, basal insulin and HOMA IR and HOMAbetacell were significantly different when compared to after treatment levels for each group (p<0.01). Significant differences were also found when comparing basal blood glucose reduction (51.8%; p<0.01), post-prandial blood glucose (55.0%; p<0.05), and HOMA IR (65.3%; p<0.01) of group B (Metformin + low glimepiride dose) with the other therapeutic options. We conclude that metformin plus glimepiride at a low dose is a more effective treatment for type 2 diabetes than other therapeutic options. HOMA IR and HOMAbetacell are inexpensive and reliable methods to study IR and beta cell function in DM2.