Gliclazide Mainly Affects Insulin Secretion in Second Phase of Type 2 Diabetes Mellitus

We studied the effect of the acute administration of gliclazide at 160 mg on insulin release during hyperglycaemic clamps in 12 type 2 diabetes patients, age 50 ± 9.0 years, diabetes duration 5.5 ± 4.8 years, fasting blood glucose 9.6 ± 2.1 mmol/L (means ± SD). After a 210 min of hyperinsulinaemic euglycaemic clamp (blood glucose 4.6 ± 0.14 mmol/L), gliclazide or placebo (randomised, double-blind, cross-over) was administered; 60 minutes later, a hyperglycaemic clamp (4 hr) at 8 mmol/L was started. Plasma C-peptide levels increased significantly after the administration of gliclazide (increment 0.17 ± 0.15 vs. 0.04 ± 0.07 nmol/L, p = 0.024) before the clamp. After the start of the hyperglycaemic clamp, the areas under the curve (AUC) for insulin and C-peptide did not differ from 0 - 10 min (first phase) with gliclazide. However, second-phase insulin release (30 - 240 min) was markedly enhanced by gliclazide. AUC plasma insulin (30 to 240 min) was statistically significantly higher after gliclazide (12.3 ± 13.9 vs. - 0.56 ± 9.4 nmol/L × 210 min, p = 0.022); similarly, AUC plasma C-peptide (30 to 240 min) was also higher: 128 ± 62 vs. 63 ± 50 nmol/L × 210 min, p = 0.002). In conclusion, in long-standing type 2 diabetes the acute administration of gliclazide significantly enhances second phase insulin release at a moderately elevated blood glucose level. In contrast to previous findings in mildly diabetic subjects, these 12 type 2 diabetes patients who had an inconsiderable first phase insulin release on the placebo day, only showed an insignificant increase in first phase with gliclazide.

Key words:

Gliclazide - Insulin Secretion - Type 2 Diabetes

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