Changes in prandial glucagon levels after a 2-year treatment with vildagliptin or glimepiride in patients with type 2 diabetes inadequately controlled with metformin monotherapy.
OBJECTIVE
To determine if the dipeptidyl peptidase-4 inhibitor vildagliptin more effectively inhibits glucagon levels than the sulfonylurea glimepiride during a meal.


METHODS
Glucagon responses to a standard meal were measured at baseline and study end point (mean 1.8 years) in a trial evaluating add-on therapy to metformin with 50 mg vildagliptin b.i.d. compared with glimepiride up to 6 mg q.d. in type 2 diabetes (baseline A1C 7.3 +/- 0.6%).


RESULTS
A1C and prandial glucose area under the curve (AUC)(0-2 h) were reduced similarly in both groups, whereas prandial insulin AUC(0-2 h) increased to a greater extent by glimepiride. Prandial glucagon AUC(0-2 h) (baseline 66.6 +/- 2.3 pmol . h(-1) . l(-1)) decreased by 3.4 +/- 1.6 pmol . h(-1) . l(-1) by vildagliptin (n = 137) and increased by 3.8 +/- 1.7 pmol . h(-1) . l(-1) by glimepiride (n = 121). The between-group difference was 7.3 +/- 2.1 pmol . h(-1) . l(-1) (P < 0.001).


CONCLUSIONS
Vildagliptin therapy but not glimepiride improves postprandial alpha-cell function, which persists for at least 2 years.
Ahrén
Bo
B
Department of Medicine, Lund University, Lund, Sweden. bo.ahren@med.lu.se
Foley
James E
JE
Ferrannini
Ele
E
Matthews
David R
DR
Zinman
Bernard
B
Dejager
Sylvie
S
Fonseca
Vivian A
VA
D000218:Adamantane / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005934:Glucagon / Q000097:blood*; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D008687:Metformin / Q000627:therapeutic use*; D009570:Nitriles / Q000494:pharmacology / Q000627:therapeutic use*; D019518:Postprandial Period / Q000187:drug effects*; D011759:Pyrrolidines / Q000494:pharmacology / Q000627:therapeutic use*; D013453:Sulfonylurea Compounds / Q000494:pharmacology / Q000627:therapeutic use*; D000077597:Vildagliptin
D007004:Hypoglycemic Agents; D009570:Nitriles; D011759:Pyrrolidines; D013453:Sulfonylurea Compounds; C057619:glimepiride; D005934:Glucagon; D008687:Metformin; D000077597:Vildagliptin; D000218:Adamantane