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DGReview
Repaglinide Combined with Bedtime Insulin May be Similar to Gliclazide/Insulin Combination Therapy for Type 2 Diabetes
A DGReview of :"Comparison of repaglinide vs. gliclazide in combination with bedtime NPH insulin in patients with Type 2 diabetes inadequately controlled with oral hypoglycaemic agents"
Diabetic Medicine
12/01/2003
By Keely S. Solomon, PhD
Combining repaglinide with bedtime NPH insulin affects glycaemic control and weight gain similarly to gliclazide/insulin combination therapy for patients with type 2 diabetes, according to a recent British study.
Insulin therapy can often be undesirable for patients with type 2 diabetes because of weight gain and increased risk of hypoglycaemia. However, studies have shown that combining bedtime NPH insulin with oral agents can produce glycaemic control similar to insulin monotherapy, but with lower insulin doses, less weight gain, and less hypoglycaemia.
Most combination therapy regimens using bedtime NPH insulin target fasting glycaemia, "but controlling meal-related glycaemic rides may also be important," writes Niall Furlong, of Whiston Hospital, Prescot, Merseyside.
To test this idea, Dr. Furlong and colleagues performed a randomised controlled trial comparing the effects of repaglinide versus the sulphonylurea, gliclazide, combined with bedtime NPH insulin in type 2 diabetics. Repaglinide, a meglitinide, is a short acting beta-cell stimulator that mediates insulin release in a glucose-dependent manner.
Forty-one patients with type 2 diabetes received bedtime NPH insulin in combination with repaglinide 4 mg t.i.d. (mean age, 59; 51% males) and 39 patients received gliclazide 160 mg b.i.d. (mean age, 59; 54% males) for 13 weeks. All patients included in the trail had inadequate glycaemic control (HbA1c>7.0%) despite maximal oral hypoglycaemic therapy.
The 2 treatments showed a similar level of efficacy for all the outcomes measured, including glycaemic control, weight gain, and hypoglycaemic episodes. Glycaemic control improved from 9.2% to 8.2% for the gliclazide group and from 9.4% to 8.5% for the repaglinide group, average weight gain was 4.1±0.5 (gliclazide) and 3.4±0.4 kg (repaglinide), and average number of hypoglycaemic episodes per patient was 2.95±0.82 (gliclazide) and 2.3±0.52 (repaglinide).
"Gliclazide and repaglinide were equally effective when combined with a bedtime injection of NPH insulin for patients with Type 2 diabetes inadequately controlled with oral agents alone," the researchers conclude.
Although fasting glycaemia was similar in both groups, the researcher note that only around 40% had a fasting blood glucose in the target range (4.0-6.0mmol/L) at final visit. Based on this observation, they suggest that, "if 'good' glycaemic control (HbA1c<7%) is to be achieved, it is likely that lower target fasting glucose levels will be required."
Diabet Med 2003 Nov;20:11:935-41.
"Comparison of repaglinide vs. gliclazide in combination with bedtime NPH insulin in patients with Type 2 diabetes inadequately controlled with oral hypoglycaemic agents"
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