The efficacy and safety of miglitol therapy compared with glibenclamide in patients with NIDDM inadequately controlled by diet alone

P. Segal, P. U. Feig, G. Schernthaner, K. P. Ratzmann, J. Rybka, D. Petzinna, C. Berlin

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE - To compare the therapeutic effects of the α-glucosidase inhibitor miglitol (BAY m 1099), the sulfonylurea glibenclamide, and placebo on parameters of metabolic control and safety in patients with NIDDM that is inadequately controlled by diet alone. RESEARCH DESIGN AND METHODS - After a 4-week placebo run-in period, 201 patients in 18 centers were randomized in a double-blind manner to miglitol (50 mg t.i.d., followed by 100 mg t.i.d.), glibenclamide (3.5 mg q.d./b.i.d.), or placebo for 24 weeks. Efficacy criteria were changes form baseline of HbA(1c) fasting and postprandial blood glucose and insulin levels, body weight, and serum triglycerides. RESULTS - Efficacy was assessed in 119 patients who completed the full protocol, and the results were similar to those obtained in 186 patients who fulfilled the validity criteria for analysis. Compared with placebo, mean baseline-adjusted HbA(1c) decreased by 0.75% (P = 0.0021) and 1.01% (P = 0.0001) in the miglitol and glibenclamide treatment groups, respectively. Blood glucose decreased slightly in the fasting state and considerably in the postprandial state in both treatment groups but not in the placebo group. Fasting insulin levels increased slightly (NS) in all treatment groups; however, postprandial insulin levels decreased with miglitol, while increasing markedly with glibenclamide (P = 0.0001) between all treatment groups). Gastrointestinal side effects (flatulence and diarrhea) occurred mostly in the miglitol- treated patients, while some glibenclamide-treated patients had symptoms suggestive of hypoglycemia. CONCLUSIONS - Miglitol monotherapy is effective and safe in NIDDM patients. Compared with glibenclamide, it reduced HbA(1c) less effectively and caused more gastrointestinal side effects. On the other hand, glibenclamide, unlike miglitol, tended to cause hypoglycemia, hyperinsulinemia, and weight gain, which are not desirable in patients with NIDDM.

Original languageEnglish
Pages (from-to)687-691
Number of pages5
JournalDiabetes Care
Volume20
Issue number5
DOIs
StatePublished - May 1997
Externally publishedYes

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