A comparative study of the glycemic control of various antidiabetic agents and the role of homocysteine in the therapy of type 2 diabetes mellitus.

OBJECTIVES

The objectives of this study were to evaluate and to compare the glycemic control of various antidiabetic agents and the role of homocysteine in type 2 diabetes mellitus.

RESEARCH DESIGN AND METHODS

Two hundred forty patients with type 2 diabetes mellitus, divided into Groups 1-6 (n=40), received glipizide, glipizide-SR, glimepiride, glibenclamide, metformin, and insulin followed by an oral hypoglycemic agent, respectively. They were evaluated with respect to glycemic control, serum insulin, safety, and quality of life (QoL) for 24 weeks. Furthermore, poorly controlled patients with elevated serum homocysteine were divided into two groups, of which received folic acid for 4 weeks.

RESULTS

Glipizide-SR significantly improved glycemic control at lower serum insulin levels, was well tolerated, and improved QoL. Metformin improved glycemic control and reduced insulin resistance in obese type 2 diabetes mellitus patients. Initial insulin therapy led to rapid reduction in hyperglycemia with reduced insulin resistance. Folic acid therapy significantly (P<.001) lowered elevated serum homocysteine levels in poorly controlled patients.

CONCLUSIONS

Glipizide-SR emerged as the sulfonylurea of choice in lean type 2 diabetes mellitus patients, while metformin was preferable for obese type 2 diabetes mellitus patients. Short-course insulin therapy with subsequent oral hypoglycemic agent could obviate the need for continuous insulin therapy in poorly controlled type 2 diabetes mellitus patients. Folic acid constitutes an inexpensive and safe therapy for hyperhomocysteinemia in patients with type 2 diabetes mellitus.