経口血糖降下薬未治療患者におけるインスリン分泌促進薬の比較検討

Comparison of glimepiride and mitiglinide in drug-naïve Type 2 diabetic patients

抄録

　グリメピリドは，現在国内で最も汎用されている経口血糖降下薬である．しかし経口血糖降下薬未治療の2型糖尿病患者において，少量のグリメピリドと速効型インスリン分泌促進薬との比較には十分な報告がない．そこで，グリメピリドまたはミチグリニドで治療を開始した外来2型糖尿病患者40例において，投与16週前後のHbA_1C，1,5-AGなどを評価した．グリメピリド，ミチグリニドともにHbA_1Cを約1％低下させ，また食後血糖を反映する1,5-AGの改善も同等であった．両群で体重増加を認めず，インスリン値やプロインスリン・インスリン比にも変動はなく，低血糖などの副作用も見られなかった．その後1年間同じ薬物を継続した29例では，いずれもHbA_1Cは同等に維持され，体重増加も認めなかった．経口血糖降下薬未治療の2型糖尿病患者において，少量のグリメピリドと速効型インスリン分泌促進薬の効果，安全性は同等であり，少量のグリメピリド投与は患者負担，コンプライアンスの面からは有用と考えられた．

　Clinical efficacy of small dose of glimepiride, a sulfonylurea agent, and mitiglinide, a rapid-acting insulin secretagogue, was compared in 40 drug-naïve Type 2 diabetic patients. During 16 weeks of the observation period, both agents decreased HbA_1C levels by approximately 1％ and increased 1,5-anhydroglucitol levels, which are a good indicator of postprandial glucose excursion, and the clinical efficacy was comparable. In each group, body mass index, fasting insulin levels and ratio of proinsulin to insulin also remained unchanged. Adverse effects such as hypoglycemia were not noted during the period. In 29 patients who were placed on the same drug for 1 year including the initial 16 weeks（14 for glimepiride and 15 for mitiglinide, respectively）, the decrease in HbA_1C levels were maintained, and body mass index were also unchanged. In conclusion, clinical efficacy of small dose of glimepiride and mitiglinide was comparable in drug-naïve Type 2 diabetic patients. Glimepiride may be superior to rapid-acting insulin secretagogues in terms of cost-effectiveness and drug compliance.