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Putut Bayupurnama, Siti Nurdjanah
CaseRepClinPractRev 2007; 8:266-268
Background: Sulfonylurea treatment of diabetic liver cirrhosis (LC) patients is still controversial. The pharmacokinetic of glimepiride does not change in the LC disease. Aim of the study is to report our experience prescribing glimepiride in the diabetic LC patients who had lack of compliance with or refuse insulin treatment.
Case Report: This case study involved four diabetic and ascitic LC patients with fasting plasma glucose (FPG) ≥ 6.99 mmol/L, with lack of compliance with or refuse insulin treatment, serum creatinine level less than 132.6 μmol/L, and approved glimepiride treatment (started with 1mg/day and then increase to 2 or 3 mg/day if needed ,before meal in the morning). FPG and 2-hour postprandial (2PP) were measured before , periodically,and at the end of treatment. The treatment duration were 24 weeks in one patient and 48 weeks in 3 patients.
In general, the glimepiride lowered the fasting plasma glucose level although it did not show consistent results in all patients. Only one patient showed good control, even asymptomatic hypoglycemia, of FPG level at the end of 48 weeks of treatment. On the other hand, the 2PP level results were inconsistent and the mean value were still high.
Conclusions: Glimepiride treatment lowered fasting plasma glucose level inconsistently and did not show favorable respond to the 2-hour postprandial level in diabetic liver cirrhosis patients. Higher dose of glimepiride may be needed and clinical trial should be performed to confirm the benefit, risk and safety profile of this treatment.