Measuring Effectiveness of Glimepiride Titration Using SMBG in Patients with Mild Type 2 Diabetes

Glimepiride is a potent sulfonylurea agent and is widely used for type 2 diabetic patients, however, the safety and efficacy of glimepiride in patients with fair diabetic control (HbA1c level: 6.5-7.9%) have not been investigated so far. Therefore, we investigated the safety and efficacy of glimepiride titration using self-monitoring blood glucose (SMBG) in the achievement of strict glycemic control in fairly controlled diabetic patients. Japanese type 2 diabetic patients who were diet-controlled or treated with alpha-glucosidase inhibitor or metformin, were randomly assigned into the SMBG group with titration of glimepiride using SMBG, or the conventional therapy group (control group) without SMBG. Glimepiride was initiated at a dose of 0.5 mg/day and plasma glucose, insulin, HbA1c, and glycoalbumin levels were evaluated for 6 months in both groups. The dose of glimepiride was titrated in the SMBG group according to the SMBG levels before breakfast and dinner. The mean dose of glimepiride at 6 months tended to be higher in the SMBG than the control group (1.0±0.8 vs 0.6±0.3mg/day), but not significant. At 6 months after glimepiride treatment, HbA1c levels were significantly lower than at baseline (SMBG: 7.2±0.5 vs 6.5±0.6%, n=23, P<0.01, control: 7.3±0.4 vs 6.5±0.7%, n=24, P<0.01), although they were similar at 6 months in the two groups. Only three hypoglycemic episodes were recorded among 50 subjects. We found no efficacy of glimepiride titration protocol in this study. However, glimepiride significantly improved glycemic control in fairly controlled diabetic patients without severe hypoglycemia.