Abstract
Clinical Efficacy of Glimepiride in Type 2 Diabetes
The prevalence of type 2 diabetes mellitus is increasing at an alarming rate in developed countries and even more so in developing countries and continents. Successful management of this disease remains a major preoccupation. If diet and physical exercise alone cannot achieve the target glycaemia levels established for patients with type 2 diabetes with respect to their clinico-biological profile, then sulphonylureas and biguanides are the most potent hypoglycaemic agents. Sulphonylureas are nevertheless associated with adverse effects, the most serious being hypoglycaemia. Elderly patients and those with renal insufficiency are at the greatest risk of hypoglycaemia. Glimepiride is the most recent of the sulphonylureas. It has the advantage of offering efficacy comparable to that of other agents of the same class, as well as a distinctive metabolic profile that minimises accumulation and consequently the risk of hypoglycaemia, which occurs less frequently with glimepiride than with glibenclamide. During treatment with glimepiride, it has been observed that stimulation of insulin secretion is lower over the long term and during physical exercise than has been reported with glibenclamide. This improved adaptation to insulin secretion during exertion may well be responsible for reducing the risk of hypoglycaemia associated with physical exercise. The pharmacokinetic profile of glimepiride makes it well suited to a once-daily dosage regimen. This constitutes the main advantage of the drug, thus simplifying treatment for patients already receiving multiple drug therapy and whose treatment compliance the practitioner has reason to doubt. The hypoglycaemic sulfamide glimepiride offers several distinctive pharmacological characteristics. These include ease of prescribing, improved tolerability during physical exercise, simplified administration in patients with renal impairment and in individuals aged more than 65 years. The usual starting dosage is 1 mg/day, which can be increased to 6 mg/day. It is recommended that this single daily dose be administered before the first solid meal of the day and that patients should be warned of the risks of missing a meal following intake of the tablet. Under these conditions, current data confirm that glimepiride is an effective hypoglycaemic agent with a good tolerability profile.
Résumé
Lorsque la diététique et l’exercice physique sont insuffisants pour atteindre l’objectif glycémique fixé chez un diabétique de type 2, et selon le type clinicobiologique, les sulfamides hypoglycémiants sont, avec les biguanides, les plus puissants médicaments hypoglycémiants. Les sulfamides hypoglycémiants peuvent cependant être à l’origine d’effets indésirables dont les plus graves sont les hypoglycémies. Celles-ci sont plus redoutées chez les insuffisants rénaux et les sujets âgés. Le glimépiride est la plus récente des sulfonylurées et offre l’avantage d’une efficacité comparable à celle des autres médicaments de sa classe et d’un métabolisme spécifique qui en réduit l’accumulation et donc le risque d’hypoglycémies, qui sont moins nombreuses que sous glibenclamide. Sous glimépiride, on note une moindre stimulation de la sécrétion d’insuline à long terme et lors de l’exercice physique que sous glibenclamide. Cette meilleure adaptation de la sécrétion d’insuline à l’effort serait susceptible d’induire un moindre risque d’hypoglycémie au cours de l’exercice physique. Sa pharmacocinétique permet une prise unique ce qui constitue son principal avantage et facilite le traitement de patients polymédiqués et peu observants. Le glimépiride offre un certain nombre de qualités pharmacologiques qui constituent les spécificités principales de ce sulfamide hypoglycémiant, plus précisément la commodité de prescription, une meilleure tolérance lors de l’exercice physique, un usage plus aisé chez l’insuffisant rénal modéré et chez le sujet âgé de plus de 65 ans. Sa posologie se situe entre 1 mg/jour, dose usuelle de départ et 6 mg/jour. Cette prise unique implique d’être administrée avant le premier repas consistant de la journée et de plus, de mettre en garde les patients des risques de sauter un repas une fois le comprimé pris. Dans ces conditions, les données actuelles montrent que le glimépiride est un hypoglycémiant efficace et offrant une bonne sécurité d’emploi.
Similar content being viewed by others
Références
Harris MI, Modan M. Screening for NIDDM. Why is there no national program? Diabetes Care 1994; 17: 440–4.
Harris MI, Klein R, Welborn TA, et al. Onset of NIDDM occurs at least 4–7 yrs before clinical diagnosis. Diabetes Care 1992; 15(7): 815–9.
UKPDS Group. Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–53.
Profozic V, Metelko Z. Propriétés pharmacologiques du glimépiride: applications cliniques pour la prise en charge du diabète de type 2. Dis Manage Health Outcomes 1998; 4 Suppl. 1: 29–41.
Muller G, Hartz D, Punter J, et al. Differential interaction of glimepiride and glibenclamide with the beta-cell sulfonylurea receptor. I. Binding characteristics. Biochim Biophys Acta 1994; 1191(2): 267–77.
Badian M, Korn A, Lehr KH, et al. Pharmacokinetics and pharmacodynamics of the hydroxymetabolite of glimepiride (Amaryl) after intravenous administration. Drug Metabol Drug Interact 1996; 13(1): 69–85.
Geisen K. Special pharmacology of the new sulfonylurea glimepiride. Arzneimittel Forschung 1988; 38(8): 1120–30.
Schneider J. An overview of the safety and tolerance of glimepiride. Horm Metab Res 1996; 28(9): 413–8.
Langtry HD, Balfour JA. Glimepiride. A review of its use in the management of type 2 diabetes mellitus. Drugs 1998; 55(4): 563–84.
Muller G, Satoh Y, Geisen K. Extrapancreatic effects of sulfonylureas — a comparison between glimepiride and conventional sulfonylureas. Diabetes Res Clin Pract 1995; 28 Suppl.: S115–S137.
Kaneko T, Kaku K, Sakamoto M, et al. Study on minimum effective dose of glimepiride (HOE490) for non-insulin-dependent diabetes mellitus patients. Multicenter double blind trial compared to placebo [in Japanese]. Rinsho Iyaku 1993; 9(4): 827–48.
Goldberg RB, Holvey SM, Schneider J. A dose-response study of glimepiride in patients with NIDDM who have previously received sulfonylurea agents. The Glimepiride Protocol #201 Study Group. Diabetes Care 1996; 19(8): 849–56.
Rosenstock J, Samols E, Muchmore DB, et al. Glimepiride, a new once-daily sulfonylurea. A double-blind placebo-controlled study of NIDDM patients. Glimepiride Study Group. Diabetes Care 1996; 19(11): 1194–9.
Sonnenberg GE, Garg DC, Weidler DJ, et al. Short-term comparison of once- versus twice-daily administration of glimepiride in patients with non-insulin-dependent diabetes mellitus. Ann Pharmacother 1997; 31(6): 671–6.
Draeger KE, Wernicke-Panten K, Lomp HJ, et al. Long-term treatment of type 2 diabetic patients with the new oral antidiabetic agent glimepiride (Amaryl): a double-blind comparison with glibenclamide. Horm Metab Res 1996; 28(9): 419–25.
Dills DG, Schneider J. Clinical evaluation of glimepiride versus glyburide in NIDDM in a double-blind comparative study. Glimepiride/Glyburide Research Group. Horm Metab Res 1996; 28(9): 426–9.
Rosenkranz B. Pharmacokinetic basis for the safety of glimepiride in risk groups of NIDDM patients. Horm Metab Res 1996; 28(9): 434–9.
Massi-Benedetti M, Herz M, Pfeiffer C. The effects of acute exercise on metabolic control in type II diabetic patients treated with glimepiride or glibenclamide. Horm Metab Res 1996; 28(9): 451–5.
Kramer W, Muller G, Girbig F, et al. Differential interaction of glimepiride and glibenclamide with the beta-cell sulfonylurea receptor. II. Photoaffinity labeling of a 65 kDa protein by [3H] glimepiride. Biochim Biophys Acta 1994; 1191(2): 278–90.
Rosenkranz B, Profozic V, Metelko Z, et al. Pharmacokinetics and safety of glimepiride at clinically effective doses in diabetic patients with renal impairment. Diabetologia 1996; 39(12): 1617–24.
Bohannon N. Type II diabetes: how to use the new oral medications. Geriatrics 1996; 51(4): 33–7.
Draeger E. Clinical profile of glimepiride. Diabetes Res Clin Pract 1995; 28 Suppl.: S139–S146.
Rosskamp R, Wernicke-Panten K, Draeger E. Clinical profile of the novel sulphonylurea glimepiride. Diabetes Res Clin Pract 1996; 31 Suppl.: S33–S42.
The pharmacological treatment of hyperglycemia in NIDDM. American Diabetes Association: clinical practice recommendations 1996. Diabetes Care 1996; 19 Suppl. 1: S1–S118.
Charles MA, Balkau B, Vauzelle-Kervröedan F, et al. Revision of diagnostic criteria for diabetes. Lancet 1996; 348(9042): 1657–8.
McCance DR, Hanson RL, Pettitt DJ, et al. Diagnosing diabetes mellitus — do we need new criteria? Diabetologia 1997; 40: 247–55.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Cervantes, P. Efficacité clinique du glimépiride dans le diabète de type 2. Dis-Manage-Health-Outcomes 4 (Suppl 1), 43–49 (1998). https://doi.org/10.2165/00115677-199804001-00004
Published:
Issue Date:
DOI: https://doi.org/10.2165/00115677-199804001-00004