Study of glycemic response of oral anti-diabetic drugs in type 2 diabetic patients


  • Shashikala E. Department of Pharmacology, Mallareddy Institute of Medical Sciences, Hyderabad, Telangana, India
  • Raghawa Rao B. N. V. Consultant Cardiologist, MNR Medical College, Sangareddy, Telangana, India



Affordable, Combination therapy, Monotherapy, Non-diabetic plasma sugar levels, Oral anti-diabetic drugs, Type 2 diabetes mellitus


Background: Type 2 Diabetes Mellitus (T2DM) is one of the most common non-communicable diseases associated with short term and long term avoidable complications. The treatment of T2DM often is initiated with monotherapy of oral antidiabetic drugs, which often do not decrease the plasma sugar levels effectively and consistently that will reduce the complications associated with T2DM. Hence the current study is aimed to determine the effectiveness of commonly available and affordable oral anti-diabetic drugs (OADs) in type 2 diabetic patients.

Methods: This study consisted of 210 T2 Diabetic patients, 120 males and 90 females with a mean age of 50.93yrs were divided equally into six groups with equal number of males and females in each group depending upon the OADs they received in solo or in combination for 24weeks. After the written consent, a detail Clinical history, Clinical examination, Biochemical investigations including, Fasting plasma sugar (FPS), Post prandial sugar (PPS), Glycosylated heamoglobin (HBA1c), serum Creatinine, serum Electrolytes, Chest X-ray PA view and standard ECG were done. Repeat FPS, PPS and HBA1c were done after 4, 12 and 24weeks of study.

Results: After 4 weeks, FPS, PPS decreased significantly in combination therapy (p <0.05), while after 12weeks and 24weeks of study, FPS, PPS and HBA1c decreased significantly (p <0.01 to p <0.001 in both monotherapy and in combination therapy. Non-diabetic levels of plasma sugars were obtained in 25-45% with monotherapy and 37-57% in combination therapy. Metformin was an effective monotherapy to initiate treatment of T2DM, but eventually combination therapy was required in most of the patients. The combinations of metformin-teneligliptin and metformin-glimepiride were found to be most effective because of their favourable pharmacokinetic characters and complementary pharmcodynamic effects.

Conclusions: OADs are affordable, effective hypoglycemic agents to initiate treatment as monotherapy and for subsequent treatment as combination therapy for T2DM.


American Diabetes Association. Role of cardiovascular risk factors in prevention and treatment of macrovascular disease in diabetes. Diabetes Care. 1993;16:72-78.

Smyth S, Heron A. Diabetes and Obesity: the twin epidemics. Nat Med. 2006;12:75-80.

Ahlawat SK, Singh MM, Kumar R, Kumari S, Sharma BK. Time trends in the prevalence of hypertension and associated risk factors in Chandigarh. J Indian Med Assoc. 2002;100(9):547-72.

Kumar A, Nagtilak S, Sivakanesan R, Gunasekera S. Cardiovascular risk factors in elderly normo- lipidemic acute myocardial infarct patients- a case controlled study from India. Southeast Asian J Trop Med Pub Heal. 2009;40(3):581-92.

IDF. IDF Diabetes Atlas, 7th Ed. Brussels, Belgium: International Diabetes Federation;2015.

Gibbons GF. Hyperlipidemia of diabetes mellitus. Clin Sci. 1988;71:477-86.

American Diabetes Association. Standard of medical care in daibetes-2016. Diabetes Care. 2016;39(suppl 1):S1-S106.

Eto T, Inoue S, Kadowaki T. Effects of once-daily teneligliptin on 24-h blood glucose control and safety in Japanese patients with type 2 diabetes mellitus: a 4-week, randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab. 2012;14(11):1040-6.

Robinson AC, Burke J, Robinson S, Johnston DG, Elkeles RS. The effects of metformin on glycemic control and serum lipids in insulin-treated NIDDM patients with suboptimal metabolic control. Diabetes Care. 1998;21(5):701-5.

Weitgasser R. Effects of glimepiride on HbA1c and body weight in Type 2 diabetes: results of a 1.5- year follow-up study. Diabetes Res Clin Practice. 2003;61:13-19.

Kadowaki T, Kondo K. Efficacy, safety and dose-response relationship of teneligliptin, adipeptidyl peptidase-4 inhibitor, in Japanese patients with type 2 diabetes mellitus. Diabetes Obes Metab. 2013;15(9):810-8.

Yamanouchi T, Sakai T, Igarashi K, Ichiyanagi K, Watanabe H, Kawasaki T. Comparison of metabolic effects of pioglitazone, metformin, and glimepiride over 1 year in Japanese patients with newly diagnosed Type 2 diabetes. Diabet Med. 2005,22:980-5.

Yoon KH, Shin JA, Kwon HS, Lee SH, Min KW, Ahn YB, et al. Mortality and cardiovascular risk associated with different insulin secretagogues compared with metformin in type 2 diabetes, with or without a previous myocardial infarction: a nationwide study. Eur Heart J. 2011;32:1900-8.

Zhu H, Zhu S, Zhang X, Guo Y, Shi Y, Chen Z, Leung SW. Comparative efficacy of glimepiride and metformin in monotherapy of type 2 diabetes mellitus: meta-analysis of randomized controlled trials. Diabetol Meta Syn. 2013;5(1):70.

Miyako K. Teneligliptin: a DPP-4 inhibitor for the treatment of type 2 diabetes. Diabete Metab synd and obes. 2013;6:187-95.

Charpentier G, Fleury F, Kabir M, Vaur L and Halimi S. Improved glycaemic control by addition of glimepiride to metformin monotherapy in Type 2 diabetic patients. Diabetic Med. 2001;18:828-34.

Haupt E, Knick B, Koschinsky T, Liebermesiter H, Sachneider J, Hirche H. Oral antidiabetic combination therapy with sulphonylureas and metformin. Diabetes Metab. 1991;17:224-31.

Min W. Effect of short-term intensive therapy with glimepiride and metformin in newly diagnosed type 2 diabetic patients. J South Med Univ. 2011;31:564- 566.

Inglea P, Taleleb G. Effects of metformin in combination with glimepiride on HbA1c and body mass index in Indian patients with type 2 diabetes mellitus. J Phar Res. 2010;3(9):2177-9.

Kim MK, Rhee EJ, Han KA, Woo AC, Lee MK, Ku BJ, et al. Efficacy and safety of teneligliptin, a dipeptidyl peptidase‐4 inhibitor, combined with metformin in Korean patients with type 2 diabetes mellitus: a 16‐week, randomized, double‐blind, placebo‐controlled phase III trial. Diabetes Obesity Metab. 2015;17(3):309-12.

Kadowaki T, Kondo K. Efficacy and safety of teneligliptin added to glimepiride in Japanese patients with type 2 diabetes mellitus: a randomized, double-blind, placebo-controlled study with an open-label, long-term extension. Diabetes Obes Metab. 2014;16(5):418-25.

Milicevic Z, Raz I, Beattie SD, Campaigne BN, Sarwat S, Gromniak E, et al. Natural history of cardiovascular disease in patients with diabetes. Diabetes care. 2008;31(Supplement 2):S155-60.

Tibaldi J. Importance of postprandial glucose levels as a target for glycemic control in Type 2 diabetes. South Med J. 2009;102(1);60-66.

Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with Type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). JAMA. 1999;281(21):2005-12.

Nathan DM, Buse JB, Davidson MB, Heine RJ, Holman RR, Sherwin R, et al. Management of hyperglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. Diabetologia. 2006;49(8):1711-21.




How to Cite

E., S., & B. N. V., R. R. (2018). Study of glycemic response of oral anti-diabetic drugs in type 2 diabetic patients. International Journal of Research in Medical Sciences, 6(2), 645–652.



Original Research Articles