Glibenclamide vs Gliclazide in Type 2 Diabetes of the Elderly

Abstract

The objective of this study was to compare the effect of two sulphonylureas on the frequency of hypoglycaemic events and glycaemic control in elderly patients with Type 2 diabetes. Twenty-two untreated elderly patients were treated with glibenclamide or gliclazide in a randomized double-blind fashion. Prior to treatment, a biochemical profile, an oral glucose tolerance test, and a 2-h hyperglycaemic glucose clamp (glucose 5.4 mmol l-zs-1 above baseline) were performed. Patients were seen regularly over 6 months to assess glycaemic control and the frequency of hypoglycaemic reactions. Hyperglycaemic clamp studies and oral glucose tolerance tests were repeated at 1 and 6 months. The area under the curve for the oral glucose tolerance test (glibenclamide: 15.5 +/- 0.7; gliclazide: 14.9 +/- 0.8 mmol l-1 (p = NS)) and the haemoglobin A1C (glibenclamide: 7.4 +/- 0.2%; gliclazide: 7.9 +/- 0.5% (p = NS)) were similar at 6 months. Hypoglycaemic reactions were significantly more frequent with glibenclamide than with gliclazide: 17 vs 4 (p < 0.01). Insulin sensitivity index (ml kg-1 min-1 pmol-1 x 100) was increased significantly by glibenclamide but not gliclazide (glibenclamide: 0.284 +/- 0.116 (baseline) vs 0.518 +/- 0.102 (6 months) (p < 0.05), gliclazide: 0.260 +/- 0.048 (baseline) vs 0.358 +/- 0.048 (6 months) (p = NS)). We conclude that glycaemic control was equivalent with the two drugs but the incidence of hypoglycaemic reactions was significantly greater with glibenclamide probably because this drug increases insulin sensitivity to a greater degree.

Management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy

“…Episodes can be both prolonged and life threatening, although these are very rare. Several of the newer sulfonylureas have a relatively lower risk for hypoglycaemia (Table 1) [45,46]. In [47].…”

Lixisenatide Therapy in Older Patients With Type 2 Diabetes Inadequately Controlled on Their Current Antidiabetic Treatment: The GetGoal-O Randomized Trial

“…Hypoglycemia is a major treatment-limiting factor in older patients, and the risk of developing more severe symptoms associated with hypoglycemia increases with aging. In addition, the use of insulin and some sulfonylureas in older patients has been linked to an increased risk of hypoglycemia (8)(9)(10).…”

The use of gliclazide in the mirror of the individualized sulfonylurea therapy

“…Hypoglykaemia tekintetében mind a gliclazid és a glibenclamid [43,44], mind a két − ténylegesen, illetve funkcionálisan − pancreasszelektív SU-származék, a gliclazid és a glimepirid vonatkozásában ismertek összeve-tések [45,46]. Glykaemiás hatékonyság vonatkozásában nem volt közöttük érdemi különbség igazolható, a hypoglykaemiák gyakorisága azonban mindkét összevetés-ben szignifi kánsan alacsonyabb volt a gliclazidot szedők körében.…”