Effects of insulin glargine versus metformin on glycemic variability, microvascular and beta-cell function in early type 2 diabetes

F Pistrosch, C Köhler, F Schaper, W Landgraf, T Forst, M Hanefeld, F Pistrosch, C Köhler, F Schaper, W Landgraf, T Forst, M Hanefeld

Abstract

We investigated whether basal insulin as first-line treatment in recently diagnosed type 2 diabetes (T2D) can improve glucose control, microvascular function and preserve insulin secretion in comparison with metformin (MET). In this open-label, randomized, prospective 36-week study, 75 patients (44 m, 31 f, mean age 60.7 ± 9.2 year) were allocated to treatment with either MET 1,000 mg b.i.d. (n = 36) or insulin glargine (GLA) at bedtime (n = 39). At baseline and study end, we performed a continuous glucose monitoring for assessment of interstitial glucose (IG) and measured microvascular function using Laser-Doppler fluxmetry. GLA versus MET treatment resulted in a more pronounced reduction in FPG (Δ: 3.1 ± 2.5 vs. 1.4 ± 1.5 mmol/l; p < 0.001) and overall IG (Δ AUC. 671 ± 507 vs. 416 ± 537 mmol/l min; p = 0.04). Postprandial PG and IG differences after a standardized test meal did not reach significance. Proinsulin/C-peptide and HOMA B as marker of endogenous insulin secretion were significantly more improved by GLA. Microvascular blood flow improved only in MET-treated patients. Early basal insulin treatment with GLA in T2D patients provided a better control of FPG, overall IG load and biomarker of beta-cell function compared to the standard treatment with MET. MET treatment resulted in an improvement of microvascular function. Studies of longer duration are needed to evaluate the durability of glucose control and β cell protection with early GLA treatment.

Trial registration: ClinicalTrials.gov NCT00857870.

Figures

Fig. 1
Fig. 1
Mean interstitial glucose values of the second day (including a standardized breakfast) after 36 weeks of treatment with insulin glargine or metformin
Fig. 2
Fig. 2
Time course of fasting plasma glucose concentration (a) and body weight (b). Data expressed as mean ± SD. *p < 0.01 (ANOVA for repeated measures)
Fig. 3
Fig. 3
Fasting (0 min) and postprandial (120 min) beta-cell function assessed by proinsulin/C-peptide at baseline and study end (week 36), #p < 0.05 vs. baseline value. Data are expressed as mean ± SEM

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