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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

Lund, Soren S; Tarnow, Lise; Frandsen, Merete; Smidt, Ulla M.; Pedersen, Oluf; Parving, Hans-Henrik and Vaag, Allan LU (2008) In European Journal of Endocrinology 158(1). p.35-46
Abstract
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... (More)
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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Endocrinology
volume
158
issue
1
pages
35 - 46
publisher
Society of the European Journal of Endocrinology
external identifiers
  • wos:000252677200006
  • scopus:38949105920
ISSN
1479-683X
DOI
10.1530/EJE-07-0500
language
English
LU publication?
yes
id
fc00defe-1d5b-40cc-83de-13f55c940dd3 (old id 1199140)
date added to LUP
2008-09-11 10:26:48
date last changed
2017-01-01 04:43:41
@article{fc00defe-1d5b-40cc-83de-13f55c940dd3,
  abstract     = {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.},
  author       = {Lund, Soren S and Tarnow, Lise and Frandsen, Merete and Smidt, Ulla M. and Pedersen, Oluf and Parving, Hans-Henrik and Vaag, Allan},
  issn         = {1479-683X},
  language     = {eng},
  number       = {1},
  pages        = {35--46},
  publisher    = {Society of the European Journal of Endocrinology},
  series       = {European Journal of Endocrinology},
  title        = {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},
  url          = {http://dx.doi.org/10.1530/EJE-07-0500},
  volume       = {158},
  year         = {2008},
}