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GUIDE study: double‐blind comparison of once‐daily gliclazide MR and glimepiride in type 2 diabetic patients
Author(s) -
Schernthaner G.,
Grimaldi A.,
Di Mario U.,
Drzewoski J.,
Kempler P.,
Kvapil M.,
Novials A.,
Rottiers R.,
Rutten G. E. H. M.,
Shaw K. M.
Publication year - 2004
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2004.01381.x
Subject(s) - glimepiride , gliclazide , medicine , metformin , type 2 diabetes , hypoglycemia , diabetes mellitus , urology , gastroenterology , pharmacology , endocrinology
Background Progressive β‐cell failure is a characteristic feature of type 2 diabetes; consequently, β‐cell secretagogues are useful for achieving sufficient glycaemic control. The European GUIDE study is the first large‐scale head‐to‐head comparison of two sulphonylureas designed for once‐daily administration used under conditions of everyday clinical practice. Design Eight hundred and forty‐five type 2 diabetic patients were randomized to either gliclazide modified release (MR) 30–120 mg daily or glimepiride 1–6 mg daily as monotherapy or in combination with their current treatment (metformin or an α‐glucosidase inhibitor) according to a double‐blind, 27‐week, parallel‐group design. Efficacy was evaluated by HbA1c and safety by hypoglycaemic episodes using the European Agency definition. Results HbA 1c decreased similarly in both groups from 8·4% to 7·2% on gliclazide MR and from 8·2% to 7·2% on glimepiride. Approximately 50% of the patients achieved HbA1c levels less than 7%, and 25% less than 6·5%. The mean difference between groups of the final HbA 1c was −0·06% (noninferiority test P < 0·0001). No hypoglycaemia requiring external assistance occurred. Hypoglycaemia with blood glucose level < 3 mmol L −1 occurred significantly less frequently ( P = 0·003) with gliclazide MR (3·7% of patients) compared with glimepiride (8·9% of patients). The distribution of the sulphonylurea doses was similar in both groups. Conclusions This study provides new insights into therapeutic strategies using sulphonylureas. It shows that gliclazide MR is at least as effective as glimepiride, either as monotherapy or in combination. The safety of gliclazide MR was significantly better, demonstrating approximately 50% fewer confirmed hypoglycaemic episodes in comparison with glimepiride.