Gliclazide and insulin action in human muscle

Sulfonylureas are widely used drugs in the treatment of NIDDM when diet treatment is unsuccessful. In addition to their pancreatic effects sulfonylureas have been reported to have insulin-like and insulin-potentiating actions in vitro with respect both to glucose transport and glycogen synthase activation in isolated adipocytes and hepatocytes from rats. Glycogen synthesis in muscle accounts for the major part of non-oxidative glucose metabolism during insulin stimulation. Treatment with gliclazide of patients with NIDDM has been shown to be associated with a potentiation of both insulin-mediated glucose disposal and insulin-stimulated glycogen synthase activity in skeletal muscle. Muscle insulin receptor binding or insulin receptor kinase activity was shown not to be affected by gliclazide treatment. Whether the improved insulin sensitivity and improved insulin action on skeletal muscle glycogen synthase during gliclazide treatment is due to a direct or an indirect action of the drug is discussed.