Reappraisal of cardiometabolic stress in type 2 diabetes mellitus patients receiving glimepiride versus insulin under bitherapy.

Background: Metformin and glimepiride are the most common oral antidiabetic drugs in India, and are used with other oral hypoglycaemic agents either separately or in combination with insulin. The objective of the present study was to compare the differences in cardiometabolic markers between metformin-glimepiride therapy versus metformin-insulin therapy in patients with type 2 diabetes mellitus (T2D).

Materials and methods: We divided T2D patients into two groups. Group 1 patients were treated with metformin-glimepiride and group 2 patients were treated with metformin-insulin combination. We estimated serum insulin, hs CRP, asymmetric dimethyl arginine (ADMA), Endoglin, 8OHdG, and sEndoglin levels. Cardiac autonomic function was assessed using ECG tracings to record heart rate variability (HRV) and blood pressure variability (BPV).

Results: The most important BPV parameter, baroreflex sensitivity (BRS) was significantly lower in Group 2. A significant decrease in time-domain indices of HRV was observed in group 2, suggesting sympathovagal imbalance in metformin-insulin-treated patients. Serum NO and TAS levels were low, while sEndoglin, 8OHdG, and PSS were high in group 2, suggesting higher oxidative stress, although the level of hsCRP, indicating inflammation, was similar in both groups.

Conclusion: The glimepiride-metformin combination was more effective against vascular dysfunction, sympathovagal balance, metabolic stress, and inflammation. Cardiometabolic mediators of cardiovascular risk were higher in metformin-insulin-treated patients, despite achieving similar glycemic targets.