Rizzo M R, Barbieri M, Grella R, Passariello N, Barone M, Paolisso G
Department of Geriatrics and Metabolic Diseases, Second University of Naples, Italy.
Diabetes Metab. 2004 Feb;30(1):81-9. doi: 10.1016/s1262-3636(07)70093-9.
To compare the effect of Repaglinide vs Glimepiride on glucose- and meal-induced insulin secretion and on meal-test induced postprandial glucose excursions.
After 2 weeks washout period, a 3-Month randomised, cross-over parallel group trial of R (1 mg x 2/die) vs G (2 mg/die) in 14 patients with type 2 diabetes "naive" in diet treatment was made.
Both R and G significantly but similarly lowered fasting glucose levels and improved fasting plasma insulin levels vs baseline. Hyperglycemic clamp showed that both 1st (129.15 +/- 23.6 vs 106.90 +/- 18.6 pmol/L; p=0.01) and 2nd phase (189.42 +/- 34.4 vs 144.21 +/- 37.3 pmol/L; p=0.003) B-cell response to glucose as well as area under the curve (52.07 +/- 10.86 vs 39.54 +/- 10.27 micromol/L x 120'; p=0.005) were greater in R than G groups. Insulin action (4.0 +/- 1.1 vs 3.2 +/- 0.9 mg x Kg x 60'/microU/mL; p=0.046) was also improved by R than G administration. In the meal test, R therapy produced a more rapId induction of insulin secretion during the first part. In fact, the mean rise in insulin secretion peaked at 45 min in R (p=0.001 vs G) and at 60 min in G (p=0.001 vs R). Consequently, glucose spike at 60 min was higher in G group compared to glucose spike at 45 min in R group (p=0.002).
Our study demonstrates that R is more efficient that G on improving glucose- and meal- induced insulin secretion as well as on controlling for postprandial glucose excursion.
比较瑞格列奈与格列美脲对葡萄糖和进食诱导的胰岛素分泌以及进食试验诱导的餐后血糖波动的影响。
在2周的洗脱期后，对14例饮食治疗的初治2型糖尿病患者进行了为期3个月的随机、交叉平行组试验，比较瑞格列奈（1mg×2/日）与格列美脲（2mg/日）的疗效。
与基线相比，瑞格列奈和格列美脲均显著且相似地降低了空腹血糖水平并改善了空腹血浆胰岛素水平。高血糖钳夹试验显示，瑞格列奈组的第一相（129.15±23.6对106.90±18.6pmol/L；p=0.01）和第二相（189.42±34.4对144.21±37.3pmol/L；p=0.003）B细胞对葡萄糖的反应以及曲线下面积（52.07±10.86对39.54±10.27μmol/L×120'；p=0.005）均高于格列美脲组。瑞格列奈给药后胰岛素作用（4.0±1.1对3.2±0.9mg×Kg×60'/μU/mL；p=0.046）也比格列美脲改善得更好。在进食试验中，瑞格列奈治疗在第一部分能更快地诱导胰岛素分泌。事实上，瑞格列奈组胰岛素分泌的平均升高在45分钟时达到峰值（与格列美脲组相比，p=0.001），而格列美脲组在60分钟时达到峰值（与瑞格列奈组相比，p=0.001）。因此，格列美脲组60分钟时的血糖峰值高于瑞格列奈组45分钟时的血糖峰值（p=0.002）。
我们的研究表明，在改善葡萄糖和进食诱导的胰岛素分泌以及控制餐后血糖波动方面，瑞格列奈比格列美脲更有效。
