Effect of Combination Metformin and Gliclazide on Creatinine level in Patients Suffering from Type 2 Diabetes.

Abstract

Type 2 diabetes mellitus is one of the most common non communicable diseases worldwide. Diabetic nephropathy is a major complications in some patients with diabetes. Therefore, strict control of blood glucose level is essential to prevent or delay the onset of diabetic nephropathy. A number of antidiabetic medications are available in the market. However, only a few can be used safely in diabetic patients in chronic kidney disease. There may be a need for adjustment in dosing of the antidiabetic medications in such patients. Metformin has been recommended by the American Diabetes Association as the first line antidiabetic drug. . Monotherapy often fails to achieve the effective glycemic control for treating Type 2 diabetes. If adequate blood glucose control is not attained using a single oral agent, a combination of agent may result in better glycemic control. Better control of diabetes is essential for each of the patients to reduce the risk of diabetes related complications. This study was carried out to determine the combination effect of metformin and gliclazide on kidney function in type 2 diabetes patients. The other objective of the study was to assess whether the combination of metformin with gliclazide result in better glycemic control.This is a collaborative study between East West University(EWU) and Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM). A total of200 patients were enrolled in BIRDEM hospital, Dhaka city, Bangladesh.Male and female patients aged between 40 and 65 years suffering from Type 2 diabetes were included in this study. The patients were treated with Metformin and Gliclazide; Metformin and Insulin and also other combination of oral antidiabetic drugs. Fasting glucose levels and creatinine levels were measured in Type 2 diabetes patients treated with different combinations of antidiabetic medications. The prescription of allpatients suffering from Type 2 diabetes mellitus were analyzed by using the Microsoft Excel and GraphPad Prism 6 software. The present study shows that the age (years)of patients treated with Metformin + Gliclazide and Metformin + Insulin was 46.64±7.393 and43.95±9.761(p = 0.2381) respectively. The fasting blood glucose (FBG) of the patients treated with Metformin and Gliclazide was 8.580±2.300 mmol/L and Metformine and Insulin was 10.20 ± 3.836 mmol/L. The difference was not statistically significant (p=0.0603).The creatinine level of Metformin and Gliclazide group was 1.919 ± 2.691 mg/dl and Metformin withInsulin was 0.9538±0.2943.There was no significant difference between the groups.The age (years) of patients (46.64±7.393)treated with Metformin + Gliclazide and the age of patient (44.3±9.805) treated with other antidiabetic drugs was not significantly different (p=0.1644). The FBG of patients in Metformin + Gliclazide group was 8.58±2.300 mmol/L and other antidiabetic drugs group was 9.485±4.300 mmol/L; p=07773. The serum creatinine level of patients in Metformin + Gliclazide groupand other antidiabetic drugs group was 1.919±2.691 and 1.009±0.3210 respectively. There was no significant difference between the groups (p=0.6964).Metformin and Gliclazide is a good combination of drug for the adequate control of blood glucose level in Type 2 diabetes patients. This combination does not significantly elevate the creatinine level when compared to Metformin and Insulin combination.Further study is needed to determine the efficacy and safety of Metformin and Gliclazide combination inlarge group of patients with type 2 diabetes.