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Repaglinide may be effective vs. sulfonylurea in older adults with type 2 diabetes
Lean older adults with type 2 diabetes experienced lower glycated albumin levels and less glucose variability when using repaglinide vs. sulfonylurea, according to study results from researchers in Japan.
“Analysis of continuous blood glucose monitoring systems to evaluate the glycemic control achieved using [sulfonylureas] has shown that asymptomatic hypoglycemia is common. In addition, [sulfonylureas] are often insufficient to manage postprandial hyperglycemia,” Hideaki Miyoshi, MD, department of rheumatology, endocrinology and nephrology, faculty of medicine at the Graduate School of Medicine, Hokkaido University, Japan, and colleagues wrote. “Glinides could therefore be indicated specifically for elderly patients with type 2 diabetes because of the lower risk of hypoglycemia associated with their use, and their greater effect on postprandial hyperglycemia. However, they have been believed to be less efficacious at lowering blood glucose than [sulfonylureas].”
In a prospective, randomized, open-label, controlled trial, Miyoshi and colleagues enrolled 52 adults between July 2016 and February 2017 at seven sites in Hokkaido, Japan, to assess the glycemic effects of repaglinide in lean older patients with type 2 diabetes. All participants had type 2 diabetes (> 80% with duration > 10 years), were aged 60 to 90 years (mean age, 72.3 years), had BMI less than 25 kg/m2 and had been prescribed a sulfonylurea for at least 12 weeks before enrollment (> 70% with duration > 10 years). Researchers randomly assigned participants to continue their sulfonylurea regimen (n = 26) or to replace their sulfonylurea with 0.5 mg repaglinide three times per day for 12 weeks.
At the end of the trial period, HbA1c levels did not change from baseline for those who continued taking sulfonylurea or those in the repaglinide group. However, glycated albumin and the ratio of glycated albumin to HbA1c improved significantly in the repaglinide group (change, 0.12 and 0.01, respectively) compared with the sulfonylurea group (change, –1.15 and –0.13, respectively; P < .01). Among the repaglinide group, lower sulfonylurea dose was associated with improvement in glycated albumin; mean sulfonylurea dose was 0.78 mg for those with improvement vs. 1.36 mg for those without.
“One possible reason for the discrepancy between the HbA1c and [glycated albumin] data is the disparity in the timescale required to reveal an effect on glycemic control: 12 weeks could be too short a period to detect a change in HbA1c,” the researchers wrote. “In clinical research, glycemic [standard deviation] in CGM has been strongly associated with the [glycated albumin]/HbA1c ratio. Although CGM is relatively convenient in our clinics, it is not practical or cost-efficient to use CGM for every patient. Thus, the [glycated albumin] /HbA1c ratio might represent a useful alternative means of predicting blood glucose fluctuations in daily medical practice.” – by Phil Neuffer
Disclosures: Miyoshi reports he receives research funding from Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo, Dainippon Pharma, Eli Lilly, Mitsubishi Tanabe Pharma Co., MSD, Novo Nordisk, Sanofi, Takeda Pharmaceutical, Kowa Pharmaceutical, Ono Pharmaceutical and Taisho Toyama Pharmaceutical. Please see the study for all other authors’ relevant financial disclosures.