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Item #8
Glipizide
Controls Postbreakfast Hyperglycemia
Nateglinide
better suited to patients with isolated postprandial hyperglycemia
or those with very irregular eating habits.
When
given at the recommended premeal time, glipizide is as effective as
nateglinide in controlling postbreakfast hyperglycemia in patients
with type 2 diabetes, according to a report in the December issue of
Diabetes Care.
Nateglinide
has been shown to restore the decrease in early postprandial insulin
secretion that leads to postprandial hyperglycemia, the authors
explain, and previous studies suggested that glipizide could normalize
early insulin release and reduce postprandial hyperglycemia. No
studies, however, have compared the acute premeal administration of
these two agents in controlling postprandial hyperglycemia in type 2
diabetics.
Dr.
Mary F. Carroll, and colleagues from the University of New Mexico
Health Sciences Center in Albuquerque, compared the effectiveness of
acute premeal administration of glipizide and nateglinide (both given
as recommended in the package insert) in controlling hyperglycemia
after breakfast in a crossover study of 20 patients with type 2
diabetes.
Postprandial
glucose profiles did not differ significantly after treatment with
glipizide, nateglinide, or glipizide plus nateglinide, the authors
report.
Plasma
glucose levels 4 hours after eating were significantly lower after
glipizide or glipizide-plus-nateglinide treatment than after placebo
or nateglinide treatment, the results indicate, and had returned to
fasting levels.
Peak
levels of insulin and excursions of insulin levels were higher with
glipizide than with nateglinide or placebo, the researchers note, but
integrated insulin levels and insulin levels at 30 minutes postmeal
were similarly elevated for both oral hypoglycemics.
C-peptide
changes postmeal paralleled those seen in insulin levels, the report
indicates, reflecting pancreatic release of insulin rather than
altered metabolism.
Dr.
Carroll, at Eastern New Mexico Medical Center in Roswell, New Mexico
stated "Generic glipizide is equivalent to nateglinide in the
control of postbreakfast hyperglycemia.
"Of the two agents", most patients with type 2
diabetes requiring oral hypoglycemic agents would do better with
glipizide."
"Nateglinide
may be better suited to patients with isolated postprandial
hyperglycemia (normal fasting blood glucose levels) or perhaps those
with very irregular eating habits," Dr. Carroll added.
"The
timing of glucose lowering agents in relation to meals may be very
important in optimizing the efficacy of which ever agent is
used," Dr. Carroll concluded.
Diabetes
Care 2002;25:2147-2152.
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