It is good for patients in the real world who occasionally overeat The addition of nateglinide (Starlix; Novartis) to metformin controls postprandial surges in blood glucose in patients with poorly controlled type 2 diabetes, researchers reported at the 62nd scientific sessions of the American Diabetes Association.
Dr. Kenneth S. Hershon of Albert Einstein College of Medicine in the Bronx, New York, reported results of a study of 141 patients with poorly controlled disease. Of these, 58 had been maintained on diet alone and 83 were taking metformin. Nateglinide was added to the regimens for a 12-week study period.
Dr. Hershon reported that 78% of patients in the diet-maintained group and 70% of the metformin group responded well to the addition of the rapid-onset insulinotropic agent, with a drop of postprandial hemoglobin a1c of 0.5%.
About 10% of the diet-maintained patients and 5% of the metformin patients experienced mild symptoms of hypoglycemia. Plasma glucose levels below 60 mg/dL were confirmed in 2.9% and 1.9%, respectively.
"Nateglinide works very quickly–within 5 minutes–and the effects last about 2 hours. "This drug takes away the effects of the sulfonylureas, which cause a constant stimulation of insulin. This gives a bolus and then goes away."
"Although this is not how this trial is set up and it’s not FDA-approved for this, you can use nateglinide prn. It is good for patients in the real world who occasionally overeat, such as when they go out to eat. They can take this with meals [to prevent postprandial hyperglycemia]," Dr. Hershon commented. Because of its rapid onset of action and short bioavailability, "you can use it how you see fit."