GLIBENCLAMIDE VS GLICLAZIDE IN TYPE-2 DIABETES OF THE ELDERLY

The objective of this study was to compare the effect of two sulphonyl ureas on the frequency of hypoglycaemic events and glycaemic control i n elderly patients with Type 2 diabetes. Twenty-two untreated elderly patients were treated with glibenclamide or gliclazide in a randomized double-blind fashion. Prior to treatment, a biochemical profile, an o ral glucose tolerance test, and a 2-h hyperglycaemic glucose clamp (gl ucose 5.4 mmol l(-zs-1) above baseline) were performed. Patients were seen regularly over 6 months to assess glycaemic control and the frequ ency of hypoglycaemic reactions. Hyperglycaemic clamp studies and oral glucose tolerance tests were repeated at 1 and 6 months. The area und er the curve for the oral glucose tolerance test (glibenclamide: 15.5 +/- 0.7; gliclazide: 14.9 +/- 0.8 mmol l(-1) (p = NS)) and the haemogl obin A1C (glibenclamide: 7.4 +/- 0.2 %; gliclazide: 7.9 +/- 0.5 % (p = NS)) were similar at 6 months. Hypoglycaemic reactions were significa ntly more frequent with glibenclamide than with gliclazide: 17 vs 4 (p <0.01). Insulin sensitivity index (ml kg(-1) min(-1) pmol(-1) x 100) w as increased significantly by glibenclamide but not gliclazide (gliben clamide: 0.284 +/- 0.116 (baseline) vs 0.518 +/- 0.102 (6 months) (p<0 .05), gliclazide: 0.260 +/- 0.048 (baseline) vs 0.358 +/- 0.048 (6 mon ths) (p = NS)). We conclude that glycaemic control was equivalent with the two drugs but the incidence of hypoglycaemic reactions was signif icantly greater with glibenclamide probably because this drug increase s insulin sensitivity to a greater degree.