Prospective multicentre trial comparing the efficacy of, and compliance with, glimepiride or acarbose treatment in patients with Type 2 diabetes not controlled with diet alone

Aim: To determine the efficacy of, and compliance with, glimepiride or acarbose in patients with Type 2 diabetes. Methods: Two hundred and nineteen patients with Type 2 diabetes uncontrolled by diet alone were randomized to receive either glimepiride (1, 2, 3, 4 or 6 mg once daily, n=111) or acarbose (50, 100, 150 or 200 mg 3 times daily, n=108). Both drugs were titrated in a 6-week dose-finding phase to achieve a fasting blood glucose (FBG) concentration ≤7.8 mmol/l (140 mg/dl). Patients achieving this target entered a 20-week treatment period. Efficacy was assessed by responder rate, number of patients achieving a FBG of s7.8 mmol/l, HbA 1c , blood glucose concentrations in response to a standard breakfast, body weight and compliance. Results: Glimepiride was associated with a significantly greater responder rate than acarbose (61 vs 34%, p<0.001), significantly greater decreases in HbA 1c (2.5±2.2% vs 1.8±2.2%, p=0.014) and FBG (2.6±2.6 mmol/l vs 1.4±2.8 mmol/l, p=0.004), a decreased glucose response to breakfast compared with acarbose [area under curve (AUC) end: 8.9±2.7 mmol/l vs 11.3±3.9 mmol/l, p=0.0001], and was accompanied by significantly greater compliance (91±12% vs 66±26%, p=0.0001). Weight loss during the study was observed in both the acarbose group (1.9±3.9 kg, p=0.001) and glimepiride group [0.4±5.2 kg,p=0.8 (NS)]. Conclusions: Improved efficacy and greater compliance were observed in response to treatment with glimepiride compared with acarbose, in patients with Type 2 diabetes.