Effect of acute administration of gliclazide on the glucose sensitivity of pancreatic B-cells in healthy subjects

Characteristics of pancreatic beta-cell secretion in Type 2 diabetic patients treated with gliclazide and glibenclamide

The aim of the present cross-over study was to compare the beta-cell response to gliclazide and glibenclamide administered orally during and following a hyperglycaemic clamp in sulphonylurea treated Type 2 diabetes. Nine patients (6 males), aged 61.4 (S.D. 6.9) years with a body mass index of 27.5 (3.1) kg m(-2) and HbA(1c) at baseline of 7.2 (0.9)% were included. Eight healthy control subjects underwent the same tests. Patients received 80-240 mg gliclazide or 5-15 mg glibenclamide for 6 weeks. Thirty minutes after administration of 160 mg of gliclazide or 10 mg of glibenclamide a 1-h hyperglycaemic clamp (11.0 mmol l(-1)) was begun, and followed by a 3.5-h observation period. Nadir blood glucose levels were 4.2 (1.0), 4.3 (1.2) and 3.4 (1.0) mmol l(-1) for glibenclamide gliclazide and controls, respectively (both P=0.07 vs. controls). Glucose levels decreased slowly and linearly in people with diabetes and reached nadirs after 204 (8) and 198 (18) min, respectively, after cessation of glucose infusion, while in controls, glucose levels declined steeply to a nadir at 98 (47) min (P<0.003 vs. both drugs). No first phase insulin secretion peak was observed in people with diabetes. Insulin levels remained elevated during the 3-h observation period in SU treated patients but, in control subjects decreased to baseline values within 2 h of the clamp. The proinsulin to C-peptide ratio increased during the observation period. In conclusion, the effects of glibenclamide and gliclazide on insulin secretion are very similar in patients with Type 2 diabetes who are in moderate glycaemic control, with a slow rise to lower amplitude, poor responsiveness to falling glucose levels, and raised proinsulin to C-peptide ratio.

Prevalence and clinical correlates of microalbuminuria in essential hypertension: the MAGIC Study. Microalbuminuria: A Genoa Investigation on Complications

The prevalence of microalbuminuria and its relationship with several cardiovascular risk factors and target organ damage were evaluated in a cohort of 787 untreated patients with essential hypertension. Albuminuria was measured as the albumin-to-creatinine ratio in three nonconsecutive, first morning urine samples. The prevalence of microalbuminuria was 6.7%. Albuminuric patients were more likely to be men and to be characterized by higher blood pressure, body mass index, and uric acid levels and lower HDL cholesterol and HDL cholesterol-to-LDL cholesterol ratio. Piecewise linear regression analysis demonstrated that uric acid and diastolic blood pressure significantly influence albuminuria and together account for a large part of its variations. K-means cluster analysis performed on the entire cohort of patients confirmed that microalbuminuria is associated with a worse cardiovascular risk profile. Furthermore, microalbuminuria was associated with the presence of target organ damage (eg, electrocardiographic [ECG] abnormalities and retinal vascular changes). Age and the presence of microalbuminuria act as independent risk factors for the development of ECG abnormalities and retinal vascular changes. Cluster analysis allowed us to identify three subgroups of patients who differed in the presence or absence of microalbuminuria, retinopathy, and ECG abnormalities. We conclude that the prevalence of microalbuminuria in essential hypertension is lower than previously reported. Increased urinary albumin excretion is associated with a worse cardiovascular risk profile and is a concomitant indicator of early target organ damage.

Gliclazide. An update of its pharmacological properties and therapeutic efficacy in non-insulin-dependent diabetes mellitus

Gliclazide is a second generation sulphonylurea oral hypoglycaemic agent used in the treatment of non-insulin-dependent diabetes mellitus (NIDDM). It improves defective insulin secretion and may reverse insulin resistance observed in patients with NIDDM. These actions are reflected in a reduction in blood glucose levels which is maintained during both short and long term administration, and is comparable with that achieved by other sulphonylurea agents. Gradually accumulating evidence suggests that gliclazide may be useful in patients with diabetic retinopathy, due to its haemobiological actions, and that addition of gliclazide to insulin therapy enables insulin dosage to be reduced. Thus, gliclazide is an effective agent for the treatment of the metabolic defects associated with NIDDM and may have the added advantage of potentially slowing the progression of diabetic retinopathy. These actions, together with its good general tolerability and low incidence of hypoglycaemia have allowed gliclazide to be well placed within the array of oral hypoglycaemic agents available for the control of NIDDM.