Comparison of the effectiveness of different oral glucose lowering drugs in fasting patients with type II diabetes

Document Type : Original Article

Authors

1 Department of Endocrinology, Health Research Institution, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

2 Department of Endocrinology, Diabetes Research Center,Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

3 Department of Nutrition, Faculty of Paramedicine, Diabetes Research Center,Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Abstract

Introduction: Type 2 diabetes is the most common metabolic diseases in developed and developing countries with no effective treatment options. This study purpose was to compare different regimens of oral anti-diabetic therapy effects on the type 2 diabetic patients while fasting during Ramadan.
Methods: In the double-blind controlled trial 90 patients with type 2 diabetes were divided randomly into three groups: 30 patients continued the previous dose of sulfonylurea (Group 1), 30 participants received a dose which was 25% lower than the previous sulfonylurea dose (group 2), and in the last 30 patients, repaglinide was replaced sulfonylurea (Group 3). Glucose, glycosylated hemoglobin (HbA1C), fructosamine, total cholesterol, low-density lipoprotein (LDL), high density lipoprotein (HDL), and triglycerides levels were measured in all participants before and after Ramadan. The weight and BMI were also controlled.
Results: In all intervention groups a significant decreasing was seen in the body weight, BMI, fructoseamine, total cholesterol, and LDL; and also, a significant increasing was seen in HDL. The hypoglycemia incidence was significantly lower in Group 3 than Group 1. The results in fructosamine reduction and HDL cholesterol increasing were significantly better in Group 3 compared to Group 2 (P<0.05). Significant changes were not seen in total cholesterol, LDL, triglyceride, FBS, and HbA1C levels among the three treatment groups during Ramadan.
Conclusion: The repaglinide consumption in comparing with sulfonylurea in patients with diabetes during Ramadan can cause fewer hypoglycemia, and better glycemic, and lipid control.

Keywords


1. Rathmann W, Giani G. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27 (10): 2568–9.doi: 10.2337/diacare.27.10.2568
2. Latifi SM, Karandish M, Shahbazian H, Hardani Pasand L. Incidence of Prediabetes and Type 2 Diabetes among People Aged over 20 Years in Ahvaz: A 5-Year Perspective Study (2009-2014). J Diabetes Res 2016; 2016: 4908647. doi: org/10.1155/2016/4908647.
3. Golozar A, Khalili D, Etemadi A, Poustchi H, Azeltabar A, Hosseini F, et al. White rice intake and incidence of type-2 diabetes: analysis of two prospective cohort studies from Iran. BMC Public Health 2017; 17(1): 133.  doi: 10.1186/s12889-016-3999-4
4. Nasli-Esfahani E, Farzadfar F, Kouhnavard M, Ghodssi-Ghassemabadi R, Khajavi A, Peimaniet M, et al. Iran diabetes research roadmap (IDRR) study: a preliminary study on diabetes research in the world and Iran. J Diabetes Metab Disord 2017; 16 (1): 9. doi: 10.1186/s40200-017-0291-9
5. Hosseini SA, Alipour M, Zakerkish M, Haghighizade M H. Effects of Standardized Extract of Ginseng (G115) on Biomarkers of Systemic Low-Grade Inflammation in Patients with Type 6 diabetes: A Double-blind Clinical Trial. Iranian J Endocrinol Metabol 2014; 16(3):175-82.
6. Hosseini SA, Alipour M, Zare Javid A, Ashtary Larky D, Shariatifar R. Impact of Short – Term Intake of Cinnamon on Serum Glucose and Lipid Profile in Patients with Type 2 Diabetes Mellitus. J Appl Environ Biol Sci 2014; 4(2):295- 8.
7. Ashtary-Larky D, Ghanavati M, Lamuchi-Deli N, Payami SA, Alavi-Rad S, Boustaninejad M, et al. Rapid Weight Loss vs. Slow Weight Loss: Which is More Effective on Body Composition and Metabolic Risk Factors? Int J Endocrinol Metab 2017; 15(3):e13249. doi:  10.5812/ijem.13249
8. SA Hosseini, A Ahangarpour, M Ghanavati, M Aria, M Alipour. Review effects of ginseng on improving glycemic status and other related parameters with Type 2 diabetes. J Clin Exc 2015; 4 (Special Issue), 90-107.
9. Malik U, Mahmood N, Khan KA, Hameed M, Randhawa FA, Salman S, et al. Glycaemic Control Of Type 2 Diabetic Patients During Ramazan Fasting. J Ayub Med Coll Abbottabad 2017; 29(1):102-6.
10. Salti I, Bénard E, Detournay B, Bianchi-Biscay M, Le Brigand C, Voinet CB, et al. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes care 2004; 27:2306-2311.
11. Azizi F. Islamic Fasting and health. Ann Nutr Metabol 2010; 56 (4): 273-82.  doi: 10.1159/000295848
12. Glimperide in Ramadan (GLIRA) Study Group. The efficacy and Safety of Glimepiride in The management of type 2 diabetes in Muslim Patients during Ramadan. Diabetes care 2005; 28 (2): 421-2. doi: 10.2337/diacare.28.2.421
13. AnwarA, Azmi KN, Hamidon BB, khalid BA. An open label comparative study of glimepiride versus repaglinide in type 2 diabetes mellitus muslim subjects during the month of Ramadan. Med J Malaysia 2006; 61 (1):28-35.
14. Zargar AH, SirajM, Jawa AA,Hasan M, Mahtab H. Maintenance of glycaemic control with the evening administration of a long acting sulphonylurea in male type 2 diabetic patients undertaking the Ramadan fast. Int J Clin Pract 2010; 64(8):1090-4. doi: 10.1111/j.1742-1241.2009.02262.x
15. Mafauzy M. Repaglinide versus gliben clamide treatment of type 2 diabetes during Ramadan fasting. Diabets Res Clin Pract 2002; 58(1): 45-53.
16. SariR , Balci MK, Akbas SH, AvciB. The effects of diet, sulfonylurea and repaglinide therapy on clinical and metabolic parameters in type 2 diabetic patients during Ramadan. Endocrine Res 2004; 30 (2):169-77.
17. Belkahdir J, El Ghomari H, Klocker N, Mikou A, NasciriM, Sabrim. Muslims with non-insulin dependent diabetes fasting during Ramadan: treatment with glibenclamide. BMJ 1993; 307:292-5. doi: 10.1136/bmj.307.6899.292
18. Allain CC, Poon LS, Chan CSG, Richmond W, Fu PC.Enzymatic determination of total serum cholesterol. Clin Chem 1974;20 (4):470-5.
19. Mennecart M, Mondon K, Malherbe C, Constans T. Delayed hypoglycemia induced by repaglinide in a frail elderly adult with diabetes mellitus. J Am Geriatr Soc 2014; 62(12):2460-2.  doi:10.1111/jgs.13144
20. Mantovani A, Grani G, Chioma L, Vancieri G, Giordani I, Rendina R, et al. Severe hypoglycemia in patients with known diabetes requiring emergency department care: A report from an Italian multicenter study. J Clin Transl Endocrinol 2016; 5:46-52. doi: 10.1111/jgs.13144
21. Kawamori R, Kaku K, Hanafusa T, Ioriya K, Kageyama S, Hotta N. Clinical study of repaglinide efficacy and safety in type 2 diabetes mellitus patients with blood glucose levels inadequately controlled by sitagliptin. J Diabetes Investig 2016; 7(2):253-9. doi:10.1111/jdi.12384
22. Bener A, Yousafzai MT. Effect of Ramadan fasting on diabetes mellitus: a population-based study in Qatar. J Egypt Public Health Assoc 2014;89 (2):47-52. doi: 10.1097/01.EPX.0000451852.92252.9b
23. M'guil M, Ragala MA, El Guessabi L, Fellat S, Chraibi A, Chebraoui L, et al. Is Ramadan fasting safe in type 2 diabetic patients in view of the lack of significant effect of fasting on clinical and biochemical parameters, blood pressure, and glycemic control?. Clinical and experimental hypertension 2008; 30(5):339-57.
24. Bouguerra R, Jabrane J, Maatki C, Salem B, Hamzaoui J, El Kadhi A, et al. Ramadan fasting in type 2 diabetes