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Azmet VG1 / VG2

Diabetes Mellitus

A chronic disorder of carbohydrate metabolism characterized by persistent hyperglycemia due to insulin resistance and/or insulin deficiency

Blood Glucose Levels

Fasting Plasma Glucose

 Post Prandial Glucose
Normal < 110 mg/dl  < 140 mg/dl 
Impaired Fasting Glucose( IFG) 110 - 125 mg/dl -
Impaired Glucose Tolerance  - 140 -199 mg/dl 

Diabetes : The Complications

Targets for glycemic control

ADA1 IDF2 ACE3
HbA1c < 7.0 ≤ 6.5 ≤ 6.5
Fasting/preprandial (mg/dl) 80-120 mg/dl
4.4-6.7 mmol/l
 <100 mg/dl
<5.6 mmol/l
 <110 mg/dl
<6.1 mmol/l
2-hr postprandial (mg/dl)
 <140 mg/dl
<7.8 mmol/l
 <135 mg/dl
<7.5 mmol/l
 <140 mg/dl
<7.8 mmol/l

Oral anti-diabetics : Comparative efficacy

Agent HbA1C Reduction (%)*
Metformin ~1.5
Sulfonyureas ~1.5
Glinides 1 – 1.5
Glitazones 0.5 – 1.4
Alpha Glucosidase Inhibitors 0.5 - 1
DPP-IV inhibitors DPP-IV inhibitors

Azmet Vg 1 & 2

Composition:

Glimepiride …… 1mg / 2mg

Metformin SR…… 500 mg

Voglibose…… 0.2 mg

Glimepiride

  • Third generation sulfonylurea
  • Most potent
  • Rapid onset : 2-3 hours
  • Long duration of action: 24 hours
  • Truly once- a - day : once daily dosing

Provides 24hrs glycaemic control

Glimepiride : Dual Mechanism of action

  • Increases insulin secretion by stimulating pancreatic beta cells:

Produces less insulin secretion as compared to other sulfonylureas

  • Extra-pancreatic action :
    Increases peripheral glucose utilization

Metformin SR 500 mg : Mechanism of action

Lowers the blood glucose through following mechanisms:

  • Inhibits glucose output from liver (HGO or HGP)
  • Increases peripheral glucose uptake by muscles
  • Decreases glucose absorption from GI tract
    • No effect on insulin secretion
    • No Danger of hypoglycaemia.

Metformin : Additional Beneficial actions

  • Lowers serum lipids levels :
    • 10 to 20% reduction in serum TG
    • 5 to 10% reduction in TC
    • Increases HDL

Voglibose : Mechanism of Action

  • Reversible inhibitor of Alpha Glucosidase enzymes in the small intestinal cells
  • Decreases the digestion & delays the absorption of dietary carbohydrates
  • Lowers postprandial plasma glucose & insulin levels

Voglibose : Actions

  • Reduces postprandial plasma glucose by 40-60mg/dL & FPG by 10-20mg/dL
  • Lowers postprandial insulin levels
  • Reduces postprandial triglyceride levels

Lowers HbA1C by 0.5 – 1%

Azmet Vg : Candidates

  • Patients who achieve satisfactory fasting plasma glucose levels with sulfonylurea + Metformin therapy, but still have significantly elevated postprandial plasma glucose levels.

Azmet Vg : Dose

  • Start with one tablet of Azmet Vg 1, just before breakfast or first main meal
  • If required, switch over to one tablet of Azmet Vg 2 , after 3- 4 weeks