To investigate the effects of addition of hydroxychloroquine 400 mg once daily in subjects with type 2 diabetes showing suboptimal glycemic control by insulin glargine, sitagliptin and metformin therapy.
Methods : This was an open label, multicenter, prospective study. Of 49 subjects with poorly controlled insulin-treated type 2 diabetes (baseline HbA1c, 8.5±0.5), 26 were treated with insulin glargine, sitagliptin 100 mg and metformin 1000 mg and 23 were given hydroxychloroquine in addition to insulin glargine, sitagliptin 100 mg and metformin 1000 mg. HbA1c value, daily insulin dose, body weight, serum creatinine level, plasma lipid parameters and the number of hypoglycemic events were recorded at weeks 0, 12, and 24.
Results : HbA1c decreased by 1.1% from 8.5±0.5 to 7.4±0.5 (p<0.0001) in patients treated with insulin glargine, sitagliptin and metformin plus hydroxychloroquine at week 12, and improved glycemic control continued throughout the study. At 24th weeks HbA1c was reduced to 6.9±0.5 (p<0.0001) in hydroxychloroquine treated group.Total daily insulin glargine dose was reduced significantly from 39.4 ± 8.5to 29.5 ± 4.5 units/day (p=0.00131)in patients treated with hydroxychloroquine. Body weight significantly reduced in patients treated with hydroxychloroquine (from 72.5±6.2 Kg to 68.7±7.4 kg, p=0.0114). Adding hydroxychloroquine showed a significant effect on plasma total cholesterol (215 ± 41 to 191 ± 37 mg/dl), triglyceride (218 ± 143 to 150 ± 97 mg/dl), LDL (131 ± 17 to 114 ± 9 mg/dl) and HDL cholesterol (59 ± 15 to 60 ± 14 mg/dl) (P<0.0001 vs. insulin with sitagliptin and metformin). Serum creatinine remained unchanged during the study period. The number of hypoglycemic events were much less in hydroxychloroquine group.
In our study who had poorly controlled type 2 diabetes despite basal insulin added to metformin and sitagliptin therapy, adding hydroxychloroquine resulted in a significant decrease in HbA1c. The 1.1% absolute decline in HbA1c values at 12 weeks in patients treated with insulin plus hydroxychloroquine represented a relative decline of approximately 12.9% from the baseline value. Improvement of glycemic control persisted throughout the study period. In spite of the major limitation of small sample size, we believe that this study is the first to investigate the efficacy of hydroxychloroquine in patients with poorly controlled insulin glargine treated type 2 diabetes.
Conclusion : Adding hydroxychloroquine to insulin therapy resulted in significant improvement of glycaemic control in patients with poorly controlled type 2 diabetes.
Department of Endocrinology , Nilratan Sircar Medical College , Kolkata, West Bengal, India
Kolkata, West Bengal, India
Assistant Professor, Dept. of Endocrinology and Metabolism, NRS Medical College & Hospital ,Kolkata, West Bengal, India
Faculty of “National Diabetes Educator Program” Course since 2013.
External and Internal Examiner of DDCT (Diploma in Diabetes Care and Technology) Course.
Twelve years of teaching Experience.
Co-guide for dissertation in DM (postdoctoral course in endocrinology) and MD and MS (postgraduate course) and MSc (Nursing) under The West Bengal University of Health Sciences, Kolkata since 2014
Seven Presentations in numerous National and International conference (ESICON, AACE, Indian Thyroid Society Annual Conference etc.)
Twenty Index Publication in national and International journals.
Reviewer of "Biomedical and Pharmacy Journal”, “Journal of Endocrinology and Metabolism” and “Journal of Neurosciences in Rural Practice”.
Principal and co investigator of 3 ongoing Clinical Trial Research.
Invited Faculty and Speaker in various National and State Conferences, Symposiums and Seminars (CME)