Carl-Axel Bauer

Effects on Lipid and Glucose Metabolism of the Long-Acting β2-Adrenergic Drug Precursor Bambuterol in Patients with Non-Insulin-Dependent Diabetes Mellitus

SummaryMetabolic and adverse effects of the long-acting β2-adrenergic prodrug of terbutaline, bambuterol (20mg tablet once nightly), were examined in a randomised 2 × 6-week double-blind, placebo-controlled crossover study in 19 patients with non-insulin-dependent diabetes mellitus. Compliance was assessed by tablet counts and measurement of plasma terbutaline. Three patients withdrew because of adverse effects (2 on bambuterol, 1 on placebo). Of the 16 remaining patients, 14 were on either dietary regulation alone (n = 8) or dietary regulation plus oral antidiabetic agents (n = 6), and 2 had discontinued oral antidiabetic drugs 1 week before study entry. Compliance was excellent (94 to 100%). Triglyceride levels fell more after bambuterol [0.48 (3 weeks) and 0.50 mmol/L (6 weeks)] than after placebo [0.17 (3 weeks) and 0.28 mmol/L (6 weeks)], the reduction being significant only at 3 weeks. HDL cholesterol increased from 1.06 mmol/L (baseline) to 1.18 (placebo) and 1.26 mmol/L (bambuterol). After 6 weeks, LDL cholesterol increased from 4.04 mmol/L (baseline), by 0.07 mmol/L after 6 weeks of placebo, but decreased by 0.14 mmol/L after 6 weeks of bambuterol (both cases statistically significant). There were minor increases in blood glucose of 0.6 and 0.5 mmol/L after 3 and 6 weeks of bambuterol, respectively, as compared with placebo. Neither treatment had any effect on glucose disposal in response to intravenous insulin, implying that insulin sensitivity was unchanged. Reported and recorded adverse reactions were all well-known β2-agonist effects.