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Nateglinide May Reduce Both Post- and Interprandial Glucose Levels In Patients with Type 2 Diabetes

Nateglinide therapy may lower interprandial blood glucose levels in patients with type 2 diabetes, in addition to the known effect on postprandial blood glucose levels, suggest the findings of a study using continuous blood glucose monitoring.

Measurement of blood glucose levels from the finger or forearm is often painful and inconvenient for patient with diabetes, making it difficult to obtain 24-hour blood glucose profiles for these patients. However, a new technology, CGMS, (Medtronic MiniMed, Northridge, CA) has been developed to provide continuous blood glucose monitoring.

According to Heidemarie Abrahamian, MD, of the City Hospital Vienna Lainz, Austria, CGMS "can provide more insight in the efficacy and safety of new therapeutic agents." Dr. Abrahamian and colleagues performed a study using CGMS to evaluate the effects of the new insulinotropic agent, nateglinide, over a 24-hour period in patients with type 2 diabetes. Nateglinide produces a glucose-dependent, rapid and short insulin release and has been previously shown to effectively lower mealtime blood glucose excursions.

Eighteen patients with type 2 diabetes participated in the study (mean age, 60; 11 males; mean HbA1c, 8.4%), 7 on diet only and 11 on metformin monotherapy. Patients underwent 72-hour glucose monitoring with CGMS while continuing their usual diabetes therapy and eating a standardised breakfast. Patients then started nateglinide therapy at 120 mg 3 times a day before meals. Three days after treatment, 72-hour glucose monitoring was performed again.

According to the researchers, patients showed a significant decrease in overall blood glucose values after receiving nateglinide therapy (131±21 vs. 172±34 mg/dL, P < .0004). Nateglinide therapy reduced the number of postprandial blood glucose values above 140 mg/dL within 24 hours by 50% (207 vs. 98, P < .001). In addition to a significant decrease in postprandial blood glucose levels, nateglinide also produced a decrease in fasting blood glucose (172±48 to 126±26 mg/dL, P < .0005). No severe hypoglycaemic episodes or other adverse events were associated with the therapy.

The researchers note that a significant decrease of interprandial glucose values with nateglinide therapy has not been previously demonstrated. "The significant decrease of interprandial glucose levels, besides the known effect on prandial glucose excursions, was demonstrated impressively by means of the CGMS, which is an additional helpful tool in diabetes care," they conclude.

Diabetes Technol Ther 2004 Feb;6:1:31-7. "Evaluation of a new insulinotropic agent by using an innovative technology: efficacy and safety of nateglinide determined by continuous glucose monitoring"

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