<p>Beta-cell function in type 2 diabetic patients who failed to maintain good glycemic status with a combination of maximum dosages of metformin and sulfonylurea</p>

Abstract

Background: The aim of this study was to investigate beta-cell function and examine whether sulfonylureas (SUs) are still useful in patients with type 2 diabetes (T2DM) who failed to maintain optimal glycemic control with a combination of maximum dosages of metformin and SU. Method: T2DM who had Hb A1c >8% during treatment with a combination of maximum dosages of metformin and SU were studied. After enrollment, the patients were assigned to continue maximum dosages of SU and metformin for 2 weeks and then underwent the first oral glucose tolerance test (OGTT), the Max-SU OGTT. After the Max-SU OGTT, SUs were discontinued for 4 weeks and the second OGTT, the Discont-SU OGTT, was performed. After the Discont-SU OGTT, the same SU was restarted at 25% of the maximum dosage (25%Max-SU). After taking 25%Max-SU for 4 weeks, the third OGTT, the 25%Max-SU OGTT, was performed. Metformin at the same dosage was continued throughout the study. Normal OGTT (NGT) subjects, matched for age and body mass index (BMI), were also studied. Results: There were 25 T2DM and 28 NGT subjects. There was no difference in age and BMI between the two groups. The beta-cell function during Max-SU was 0.1, which was higher than 0.06 during Discont-SU ( p <0.001) and also higher than 0.09 during 25%Max-SU ( p =0.269). The beta-cell function during 25%Max-SU was higher than during Discont-SU ( p <0.001). The beta-cell function of the NGT group was 0.34 and higher than during Max-SU ( p <0.001). Fasting capillary blood glucose (FCBG) levels during Discont-SU (14.2±3.7 mmol/L) were higher than during 25%Max-SU (12.3±3.4 mmol/L) and during Max-SU (10.3±2.4 mmol/L) ( p <0.05). In addition, the FCBG during Discont-SU was higher than that during 25%Max-SU ( p <0.05). Conclusion: In T2DM patients who failed to achieve glycemic control with a combination of maximum dosages of metformin and SU, the beta-cell function declined compared to NGT subjects. However, the beta-cells were still responsive to SUs, which play a significant role in glycemic control.

A Bioinformatics Investigation into the Pharmacological Mechanisms of Sodium-Glucose Co-transporter 2 Inhibitors in Diabetes Mellitus and Heart Failure Based on Network Pharmacology

“…For instance, metformin alone is often not enough to keep glycemia under control, and thus does not significantly improve patients' condition [8]. Sulfonylureas, used as second-line or third-line treatments for diabetic patients with heart failure according to the position statement of the European Society of Cardiology/Heart Failure Association, are commonly prescribed in DM but associated with weight gain and hypoglycemia, which are detrimental in heart failure [9][10][11]. Therefore, there is a compelling impetus to explore potential strategies to reduce the risk of HF in patients with DM.…”

Gluco-regulation & type 2 diabetes: entrenched misconceptions updated to new governing principles for gold standard management

“…Sulfonylureas have long been speculated to overextend beta cells, pushing the cells to exhaustion. This remains a contentious proposition, but is nonetheless supported by strong associations of use of sulfonylureas with rapid treatment failure ( 37 ) accompanied by loss of beta cell mass ( 38 – 40 ), and, in preclinical studies, evidence of sulfonylurea-induced beta cell apoptosis ( 41 ).…”

Time to reposition sulfonylureas in type 2 diabetes management in Indian context: A pragmatic practical approach

“…The β-cells in the pancreas can still be stimulated by SUs to secrete insulin, which helps in glycemic control. Therefore, if other OHAs or insulin is being considered to lower blood sugar levels, SUs can still be used, but caution should be taken to prevent hypoglycemia [ 32 ].…”