A dose-response study of glimepiride in patients with NIDDM who have previously received sulfonylurea agents. The Glimepiride Protocol #201 Study Group.
OBJECTIVE
To assess the efficacy, safety, and dose-response relationship of glimepiride in patients with NIDDM.


METHODS
After a 21-day placebo washout period, 304 patients were randomized to receive either placebo or glimepiride, 1, 4, or 8 mg once daily. Fasting plasma glucose (FPG), 2-h postprandial glucose (PPG), and HbA1c were measured at predetermined intervals during the washout period and the 14-week study. Adverse events were tabulated.


RESULTS
At each patient visit, reduction from baseline FPG was greater in each glimepiride group than in the placebo group (P < 0.001). Changes from baseline to endpoint after 1, 4, and 8 mg glimepiride exceeded those after placebo (P < 0.001) by 2.4, 3.9, and 4.1 mmol/l, respectively, for FPG; by 1.2, 1.8, and 1.9 percentage points, respectively, for HbA1c; and by 3.5, 5.1, and 5.2 mmol/l, respectively, for 2-h PPG. Greater reductions in these parameters were observed with 8 and 4 mg than with 1 mg (P < 0.05), indicating a dose-response relationship. When patients with baseline HbA1c levels > or = 8% were assessed, more patients who received 8 mg glimepiride had HbA1c values < 8% at endpoint compared with patients receiving 4 mg. Glimepiride had a favorable safety profile.


CONCLUSIONS
Glimepiride in 1-, 4-, or 8-mg doses was effective and well tolerated. Although the 4- and 8-mg once-daily doses were significantly more potent than the 1-mg dose, all three doses yielded clinical improvement. Because the 8-mg dose controlled HbA1c values in a greater number of patients with high baseline HbA1c levels than did the 4-mg dose, this higher dose might be beneficial for patients who are difficult to treat.
Goldberg
R B
RB
Diabetes Research Institute, University of Miami School of Medicine, Florida 33136, USA.
Holvey
S M
SM
Schneider
J
J
D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005215:Fasting; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010919:Placebos; D019518:Postprandial Period; D013453:Sulfonylurea Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D016312:Treatment Refusal
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D010919:Placebos; D013453:Sulfonylurea Compounds; C057619:glimepiride