Diabetologie und Stoffwechsel 2012; 7 - P_94
DOI: 10.1055/s-0032-1314591

Comparative investigation of basal insulin glargine versus metformin as first line drug in patients with type 2 diabetes on B-Cell and endothelial function

F Pistrosch 1, F Schaper 1, M Hanefeld 1, T Forst 2, C Köhler 3, W Landgraf 4
  • 1GWT-TUD GmbH, Studienzentrum Professor Hanefeld, Dresden, Germany
  • 2IKFE GmbH, Mainz, Germany
  • 3GWT-TUD GmbH, Medizin Consulting, Dresden, Germany
  • 4Sanofi Aventis, Frankfurt, Germany

Metformin (MET) as first line drug fails to prevent disease progression. Early use of insulin might be able to preserve beta cell function. We compared effect on B-Cell function, endothelial function and cardiovascular risk factors.

Open-label, randomized, prospective 36-wk study. 75 eligible drug naive patients (45/30m/f, age 60.7±9.2 yr), HbA1c between 6.5 & 8.5% were allocated to MET 1000mg b.i.d. (n=36) or insulin glargine (GLA) at bedtime (n=39). GLA dose was adjusted to target fasting plasma glucose (FPG) <5.6mmol/l. At baseline and study end proinsulin and C-peptide levels, glucose homeostasis by CGMS, insulin secretion, endothelial function and cardiovascular (CV) risk factors were measured.

GLA treatment compared to MET resulted in a more pronounced reduction of FPG (Δ: 3.1±2.5 vs.1.4±1.5 mmol/L; p<0.001), decrease of mean interstitial glucose (IG) level during CGM (Δ: 2.4±1.8 vs. 1.4±1.8mmol/l; p=0.02) and overall IG-area under the curve (AUC Δ: 671.2±507.9 vs. 416.1±537.6 mmol/L min; p=0.04). 2-h pp PG after test meal as well as IG-AUC differences after test meal and HbA1c were not significantly different between treatment groups. A significant reduction of proinsulin to Cpeptide ratio compared to baseline was found for both interventions however insulin treatment resulted in a significantly better improvement in proinsulin/Cpeptide ratio than MET. Diastolic blood pressure was significantly reduced with GLA (Δ: -4.4±6.7mmHg) bbut remained constant with MET. No significant differences were observed for effects on blood lipids, albumin/creatinine ratio and hsCRP. Endothelial dysfunction measured with Laser Doppler Velocimetry (O2C) was improved by MET treatment compared to GLA.

Early GLA insulin treatment in T2D patients showed better control of FPG and overall glycemic load than MET. This was associated with improved B-cell function. MET improved endothelial function whereas GLA improved diastolic blood pressure.