Gliclazide mainly affects insulin secretion in second phase of type 2 diabetes mellitus

We studied the effect of the acute administration of gliclazide at 160 mg o n insulin release during hyperglycaemic clamps in 12 type 2 diabetes patien ts, age 50 +/- 9.0 years, diabetes duration 55 +/- 4.8 years, fasting blood glucose 9.6 +/- 2.1 mmol/L (means +/- SD). After a 210 min of hyperinsulin aemic euglycaemic clamp (blood glucose 4.6 +/- 0.14 mmol/L), gliclazide or placebo (randomised, double-blind, cross-over) was administered; 60 minutes later, a hyperglycaemic clamp (4hr) at 8mmol/L was started. Plasma C-pepti de levels increased significantly after the administration of gliclazide (i ncrement 0.17 +/- 0.15 vs. 0.04 +/- 0.07 nmol/L, p = 0.024) before the clam p. After the start of the hyperglycaemic clamp, the areas under the curve ( AUC) for insulin and C-peptide did not differ from 0-10 min (first phase) w ith gliclazide. However, second-phase insulin release (30-240 min) was mark edly enhanced by gliclazide. AUC plasma insulin (30 to 240 min) was statist ically significantly higher after gliclazide (72.3 +/- 13.9 vs. -0.56 +/- 9 .4 nmol/l x 210 min, p = 0.022); similarly, AUC plasma C-peptide (30 to 240 min) was also higher: 128 +/- 62 vs. 63 +/- 50 nmol/L x 210 min, p = 0.002 ). In conclusion, in long-standing type 2 diabetes the acute administration of gliclazide significantly enhances second phase insulin release at a mod erately elevated blood glucose level. In contrast to previous findings in m ildly diabetic subjects, these 12 type 2 diabetes patients who had an incon siderable first phase insulin release on the placebo day, only showed an in significant increase in first phase with gliclazide.